B   3    B^W   bS'^ 


M 


•  •••••  •  •,, 

••••••   •    ••• 

•••••••  *,  I 

'••  /.  :  ;  :••••  ?•.  . 


IRVING  FISHER 
MISCELLANEOUS  WRITINGS 
1907-1917 


The  effect  of  diet  on  endurance..,   1907. 

A  graphic  method  In  practical  dietetics.   1907. 

Insurance  companies  and  the  public  health. . .1910 • 

The  life  extension  institute...   1914. 

National  vitality. •.   1910. 

The  need  for  health  insurance.   1917. 

The  public  health  movement.   1912. 

The  "ratio"  chart  for  plotting  statistics.  1917. 

Sale  of  intoxicating  liquors...  1912. 


«  ■  «      » 

#  e  «    e        « 

•  «  •   «         • 

•  «  e    •     •       < 

,  ,       €        e« 


.      *       •     •   •  «         •  •    .       . 
.    ^  •      -     •, •   •       •    •      •.• 
•    <«•••        • 


•  •  •  • 
...  , 

•  •  «   *  .     . 

I  .  .    .  •      • 


^:!^'J^'^     PUBLIC 

fe*»»'*'^^''       HEALTH 

LiERAJRt 


/^ 


If, 

REPRINTED  FROM  THE  TRANSACTIONS  OF  THE 
'^        CONNECTICUT  ACADEMY  OF  ARTS  AND  SCIENCES 


lNroKi(>K\Ti-i)  A.  D.  1799 


VOLUME  XIII.     PP.  1-46 


MAY,  1907 


Publications  of  Yale  University 


/f^7'/f/; 


/ 


THE  EFFECT  OF  DIET  ON  ENDURANCE 

BASED   ON   AN   EXPERIMENT,   IN  THOROUGH    MASTICATION, 

WITH    NINE   HEALTHY   STUDENTS 

AT  YALE  UNIVERSITY,  JANUARY  TO  JUNE,   1906 


IRVINgIfISHER,  Ph.D. 

Professor  of  Political  Economy  at  Yale  University 


NEW  HAVEN.  CONNECTICUT 

1907 

THE    TUTTLE,   MOREHOUSE    &    TAYLOR    PRESS 


I. — The  Effect  of  Dikt  on  Endurance,  Based  on  an  Experi- 
ment Avnii  XiNK  IIeai/fhy  Students  at  Yale  University. 

January-June,  190G. 

Introduction. 

There  appears  to  be  very  little  literature  on  the  subject  of  endur- 
ance. Since  the  epoch-making  work  of  Mosso,  much  has  been  written 
on  fatigue,  and  niau}^  varieties  of  ergographs  have  been  constructed 
to  record  muscular  fatigue  ;  but  no  systematic  study  of  endurance 
as  such  aj)j)ears  to  have  been  made.  Even  the  concept  of  endurance, 
as  related  to  strength  and  fatigue,  has  been  lacking.  No  corre- 
lations have  been  worked  out  between  endurance  and  the  factors 
upon  which  it  di'pends,  except  that  it  has  been  a  matter  of  common 
experience  that  endurance  increases  with  exercise.  In  respect  to 
diet,  opinions  as  to  its  relation  to  endurance,  so  far  as  the  writer  knows, 
have  rested  on  no  better  foundation  than  the  personal  impressions  of 
adherents  of  special  dietary  systems,  such  as  those  of  Salisbury, 
Dewey,  Haig,  Kellogg,  and  Fletcher.  In  Professor  Chittenden's 
painstaking  studv  on  "Physiological  Economy  in  Nutrition"  he  has 
shown  that  one  result  of  a  gradual  and  systematic  reduction  in  proteid, 
from  the  amount  ordinarily  consumed,  has  been  an  increase  in  strength, 
but  no  data  were  obtained  in  resj^ect  to  endurance. 

The  present  experiment  had  a  somewhat  accidental  origin.  I  was 
engaged  in  collecting  statistics  of  labor-power  in  relation  to  various 
factors,  among  them  especially  diet.  The  data  were  collected  because 
of  their  economic  bearings  and  without  any  intention  at  first  of  mak- 
ing independent  experiments.  But  some  of  my  students,  whom  I  had 
engaged  to  make  computations  and  diagrams,  became  interested  in 
the  material  with  which  they  thus  came  in  contact,  and  expressed  a 
strong  desire  to  try  dietetic  experiments  upon  themselves.  Not 
being  a  physiologist,  I  asked  Professor  Chittenden  if  he  could  not 
take  charge  of  these  experiments  for  them.  It  so  happened  that  on 
account  of  other  similar  work  he  was  unable  to  do  so,  but  suofsfested 
that  I  should  conduct  them  myself.  I  have  done  so  with  consider- 
able hesitation,  not  being  e([uipped  for  )»hysiologic  studies.  I  have 
therefore  restricted  ni}-^  attention  to  the  simpler  practical  aspects  of 
the  problem,  although  some  of  the  technical  points  have  been  inves- 

Tran's.  CoxNN.  Acad.,  Vol.  XIII.  1  May,  1907. 

M5203507 


'*  ■•••  t    !    ••  • 


Fisher — The  Effect  of  Diet  on  Midurance. 

tigated  through  the  very  kind  cooperation  of  able  colleagues.  My 
thanks  are  especially  due  to  Professor  Chittenden  and  his  co-workers, 
Professor  Mendel  and  Dr.  Underhill,  for  the  aid  rendered  by  the 
Sheffield  Scientific  School  Laboratory  in  determining  the  nitrogen 
excreted,  and  for  much  helpful  advice  and  criticism.  I  wish  also  to 
express  my  obligations  to  Dr.  J.  P.  C.  Foster  for  his  services  as 
medical  adviser  to  the  students  ;  to  Dr.  W.  G.  Anderson,  Director 
of  the  Yale  Gymnasium,  and  his  corps  of  assistants,  through  whom 
the  endurance  tests  were  conducted  ;  to  Professor  Rettger  for  fecal 
tests  ;  and  to  the  subjects  of  the  experiment  themseh  es,  Messrs, 
Bauer,  Edwards,  Lagerquist,  Lawton,  Mitke,  Parmelee,  Reeds,  Taylor, 
and  Weyman,  whose  patient  submission  to  the  painful  tests  of  endur- 
ance was  little  short  of  heroic. 

In  January,  1906,  the  students  above  mentioned  organized  them- 
selves into  an  eating  club.  The  experiment  began  with  an  endurance 
test  on  January  14,  and  consisted  of  two  main  parts,  each  of  which 
lasted  about  ten  weeks. 

The  object  of  the  first  half  of  the  experiment  was  to  test  the  claims 
which  have  been  made  by  Mr.  Horace  Fletcher,  as  to  the  effects  upon 
endurance  of  thorough  mastication  combined  with  implicit  obedience 
to  appetite.  Our  conclusion  in  brief  is  that  Mr.  Fletcher's  claims,  so 
far  as  they  relate  to  endurance,  are  justified. 

Mr.  Fletcher's  method  may  be  briefly '  expressed  in  two  rules. 

1.  Mastication.  Thorough  mastication  of  all  food  up  to  the 
point  of  involuntary  swallowing,  with  the  attention  directed,  how- 
ever, not  on  the  mechanical  act  of  chewing,  but  on  the  tasting  and 
enjoyment  of  the  food  ;  liquid  foods  to  be  sipped  and  tasted,  not 
drunk  down  like  water.  There  should  be  no  artificial  holdins^  of  food 
in  the  mouth  beyond  the  time  of  natural  swallowing,  even  if,  as  is  to 
be  expected  at  the  start,  that  swallowing  is  premature.  It  is  not 
intended  to  "  count  the  chews,"  or  hold  the  food  forcibly  in  the  front 
of  the  mouth,  or  allow  the  tongue  muscles  to  become  fatigued  by  any 
unnatural  effort  or  position,  or  in  any  other  way  to  make  eating  a 
bore.  On  the  contrary,  every  such  effort  distracts  one  from 
the  natux'al  enjoyment  of  food.  Pawlow  has  shown  that  without 
such  attention  and  enjoyment  of  the  taste  of  food,  the  secretion  of 

1  The  reader  who  desires  to  pursue  the  subject  is  referred,  as  to  mastication 
and  instinctive  eating,  to  Higgins,  Humaniculture,  Stokes,  N.  Y.,  1906;  as  to 
proteid,  to  Chittenden,  Physiological  Economy  in  Nutrition,  Stokes,  1904  ;  and 
as  to  the  general  subject,  to  Horace  Fletcher,  The  A.  B.-Z.  of  our  oivn  Nutri- 
tion, Stokes,  1903. 


Fisher — The  Efi'ect  of  Diet  on  Endurance.  3 

gastric  juice  is  lessened.  The  [)uiiit  of  iiivoliiutaiy  swallowing  is 
thus  a  variable  point,  gradually  coming  later  and  later  as  the  practice 
of  thorough  mastication  proceeds,  until  the  result  is  reached  that  the 
food  remains  in  \\\v  mouth  without  effort  and  becomes  practically  taste- 
less. Thus  the  food,  so  to  speak,  swallows  itself,  and  the  person  eats 
without  thought  either  of  swallowing  or  of  not  swallowing  it  ;  swal- 
lowing is  put  into  the  same  category  of  physiological  functions  as 
breathing,  which  ordinarily  is  involuntary. 

•2.  Folloioinff  instinct.  Never  to  eat  when  not  hungr}',  even  if  a 
meal  (or  more  than  one,  for  that  matter)  is  skipped.  And  when  a 
meal  is  taken,  not  to  be  guided  b}^  the  quantity  of  food  offered,  or 
by  past  habit,  or  by  au}^  theories  as  to  the  amount  of  food  needed. 
The  natural  taste  or  appetite  is  alone  consulted,  and  the  subject 
selects,  from  the  food  available,  onlj'  those  kinds  and  amounts  which 
are  actually  craved  by  the  appetite.  After  practice,  the  appetite 
gradually  becomes  more  definite  and  discriminating  in  its  indica- 
tions. 

These  two  rules  —  thorough  mastication  and  implicit  obedience 
to  appetite  —  were  alone  employed  during  the  ten  weeks  which  con- 
stituted the  first  half  of  the  experiment. 

Shortly  after  the  beginning  of  the  second  half  of  the  experiment, 
there  was  an  interim  of  six  days  at  Easter  recess,  during  which  the 
few  men  who  remained  in  New  Haven  took  advantage  of  the  tempo- 
rary absence  of  the  cook  to  try  the  possibilities  of  living  without  one 
entirely.  During  this  brief  period  use  was  made  not  only  of  raw  foods, 
such  as  fruits,  nuts  and  milk,  but  also  of  foods  which  could  be  pur- 
chased already  cooked,  such  as  the  flaked  breakfast  foods.  But  all 
the  food  was  cold,  and  several  of  the  men  found  it  cheerless  and 
unsatisfactory.  Judging  from  their  feelings,  they  Avere  losing  in 
weight  and  vigor.  This  part  of  the  experiment  was  too  brief,  how- 
ever, to  justify  any  reliable  conclusiun  as  to  the  virtues  of  a  raw,  or 
rather  a  cookless,  diet. 

The  second  half  of  the  experiment  lasted  about  nine  weeks.  The 
same  two  rules  which  were  employed  during  the  first  half  were 
continued  during  the  second,  but  a  third  rule  was  added.  This  was 
the  use  of  suggestion,  as  follows  : 

3.  When  instinct  is  in  doubt,  tise  reason. — This  rule  consists  of 
acquiring  and  applying  a  little  knowledge  of  foods  and  food  elements. 
For  this  purpose,  in  the  present  experiment  two  lists  of  food  were 
given.  One  was  arranged  in  a  tentative  order  of  intrinsic  merit, 
beginning  with   fruits   and  ending  Avith  alcohol,    and  the  other  in 


4  Fisher — The  Effect  of  Diet  on  Endurance. 

the  order  of  the  proportion  of  proteid.  The  men  were  then  asked, 
when  and  only  when  the  appetite  was  entirely  vnlllng,  to  choose  the 
better  and  purer  foods  and  the  low  proteid  foods  in  preference  to 
those  high  in  proteid.  In  this  way  the  men  gradually  shifted  their 
diet  upward  in  the  two  lists,  and  thereby  jjursued  a  little  faster  the 
same  direction  in  which  they  had  already  been  found  to  be  uncon- 
sciously moving  under  the  influence  of  thorough  mastication  and 
implicit  obedience  to  appetite. 

It  would  too  greatly  lengthen  this  report  if  any  attempt  were  made 
to  repeat  in  detail  all  the  specific  advice  given  to  the  experimenters 
under  Rule  3.  What  has  been  said  covers  in  a  general  waj^  all  the 
points  except  the  advice  (subject  always  to  the  consent  of  appetite) 
to  eat  light  and  quickly  digested  suppers  in  order  to  go  to  bed  on  an 
empty  stomach. 

Careful  record  of  the  amounts  of  food  eaten  and  the  constituents 
of  proteids,  fats  and  carbohydrates  was  kept  for  each  man  each  day, 
certain  days  being  omitted  if  for  any  reason  the  record  was  incom- 
plete, as  when,  for  instance,  the  men  wei'e  out  of  town  or  took  their 
meals  away  from  the  club.'  To  avoid  weighing  at  the  table,  the 
food  was  all  weighed  in  the  kitchen  and  served  in  "standard  portions" 
of  100  calories  each,  or  simple  fractions  or  multiples  thereof,  and  the 
men  merely  recorded  the  number  of  portions  eaten.  The  proportions 
of  proteids,  fats  and  carbohydrates  were  found  by  means  of  the 
writer's  "Mechanical  Diet  Indicator."'^  Atwater  and  Bryant's 
tables  were  used  as  a  basis  for  calculation.  For  the  first  few  weeks 
the  figures  were  probably  subject  to  some  errors,  and  in  all  cases 
more  or  less  guessing  had  to  be  practiced  with  reference  to  the 
amount  of  lean  and  fat  of  meats  ;  but  the  influence  of  any  errors  on 
the  results  must  necessarily  be  small,  because  meat  supplied,  at 
the  highest,  only  a  small  fraction  of  the  total  calories.  It  is  believed 
that  the  results  are  in  general  correct  to  two  significant  figures. 

For  the  first  two  weeks  of  the  first  half  of  the  experiment,  the  men 
ate  in  their  ordinary  way.  During  the  following  eight  weeks  they 
masticated  more  thoroughly  and  followed  the  leadings  of  taste  more 
carefully.     Most  persons,  while  nominally  following  taste,  are  largely 

^  The  number  of  days  eacli  week  on  wliich  the  record  of  diet  was  kept  was  sel- 
dom under  six. 

-For  a  description  of  this  instrument,  seethe  writer's  "A  New  Method  of 
Indicating  Food  Values,"  American  Journal  of  Physiology,  April,  1906.  For  a 
description  of  its  practical  uses  see  "A  Graphic  Method  in  Practical  Dietetics," 
Jour,  of  the   Amer.  Med.  Assoc,  Apr.  20,  1907. 


lusher — The  Effect  of  Diet  o/t  Emlurance.  5 

controlled  in  their  sflection  of  foods  bv  many  other  circninstances, — 
as,  conventionality,  or  the  desire  to  eat  what  others  eat  and  the  unwil- 
lingness to  appear  "different";  politeness,  the  desire  to  ))lease  one's 
host  and  hostess  \f()0(l  notions,  the  opinion  that  certain  foods  and  cer- 
tain amounts  of  food  are  "  wholesome  "  even  if  not  palatable  and  that 
certain  foods  should  be  avoided  as  injurious  even  if  delicious  to  the 
taste  ;  narrowness  of  choice,  as  at  a  boardini^  house  table,  which 
often  su|)plies  what  is  not  wanted  and  withholds  what  is  ;  and 
habit,  by  which  the  particular  kinds  and  amounts  of  foods  which 
have  become  customary  through  the  previous  causes— conventionality, 
politeness,  food  notions,  and  narrowness  of  choice — are  repeated  day 
after  day  without  thought.  The  subjects  of  the  present  study  were 
given  a  wide  range  of  choice,  the  menu  including  fruits,  nuts,  cereals, 
puddings  and  pastry,  vegetables,  milk,  meats,  etc.  Meat  if  desired 
was  available  three  times  a  day. 

The  object  of  the  experiment  was  to  find  what  effects  on  diet  and 
endurance  would  follow  from  a  strict  obedience  to  the  taste-instinct, 
when  this  instinct  was  given  a  longer  chance  to  act  by  prolonged 
mastication  and  attentive  tasting.  Each  man  was  therefore  encour- 
aged to  choose  his  own  food  out  of  the  menu  for  the  day.  Nothing 
was  set  before  him  until  it  was  ordered,  and  even  after  a  food  was 
ordered  it  was  not  eaten  if  taste  did  not  so  dictate.  The  men  were 
specially  warned,  during  the  first  half  of  the  experiment,  against  any 
conscious  effort  to  decrease  their  food,  proteid,  or  meat  ;  and  while  it 
is  possible  that  subconscious  suggestion  played  a  part,  so  far  as  could 
be  observed  they  were  freer  from  its  influence  than  any  ordinary 
experimenter  who  might  take  up  the  same  experiment  after  reading 
Mr.  Fletcher's  or  Professor  Chittenden's  books. 

That  this  conclusion  as  to  the  relative  absence  of  subconscious  sug- 
gestion is  correct  was  evidenced  by  the  ex])eriences  both  before  and 
after  this  part  of  the  experiment.  For  a  month  })rior  to  its  actual 
beginning  (Jan.  14),  the  experiment  had  been  fully  decided  upon, 
and  its  plan  and  scope  understood  by  the  men.  Plad  subconscious 
suggestion  played  an  important  role,  it  would  probably  have  shown 
itself  in  a  reduction  of  proteid  during  this  month  ;  but  determinations 
of  the  grams  of  nitrogen  daily  excreted  in  the  urine,  taken  at  the 
beginning  and  end  of  this  month,  indicated  no  substantial  change,  as 
the  following  table  shows.  (M.  does  not  appear  in  this  table,  owing 
to  the  absence  of  any  specimen  for  December.) 


6  lusher — The  Effect  of  Diet  on  Endurance. 

TABLE  I. 

B  E         Lq        Lw  P  R  T  W  Average 

Middle  Dec.  11.3       11.1       13.8       12.3       11.3       13.9       14.2       15.9         13 

Middle  Jan.  10.4       12.7       14.3       14.3       11.1       14.8       12.2       13.4         13.1 

On  the  other  hand,  during  the  second  lialf  of  the  experiment  (Mar. 
28-June  1),  Avhen  the  force  of  suggestion  was  consciously  introduced, 
the  reduction  of  flesh  and  proteid  went  on  rapidly,  as  is  seen  m 
Table  II.  The  facts,  therefore,  seem  to  show  that  the  men  followed 
directions  closely,  avoiding  largely  the  influence  of  subconscious  sug- 
gestion and  following  that  of  conscious  suggestion  in  exact  accord- 
ance with  the  directions  given  them. 

Changes  in  Diet. 

During  the  first  two  weeks  of  the  first  period  when  no  change  of 
habits  was  undertaken,  the  food  showed  little  tendency  to  change  in 
amount  or  in  kinds.  On  the  other  hand,  for  the  remaining  eight 
weeks,  during  which  thorough  mastication  and  instinctive  eating- 
were  practiced,  there  was  a  distinct  though  gradual  tendency  toward 
reduction  in  the  amount  of  food,  in  the  quantity  of  proteid,  in  the 
quantity  of  flesh  foods,  and  in  the  quantity  of  liquids  of  all  kinds — 
water,  tea,  coffee,  cocoa,  and  even  soups.  Exact  figures  were  kept 
for  calories,  proteid  and  flesh  foods.  These  showed  that  the  total 
caloi'ies  gradually  fell  about  10^,  the  proteids,  15<fo,  and  the  flesh 
foods,  40,^, 

In  the  second  period,  during  which  the  force  of  suggestion  to 
reduce  proteid  and  flesh  foods  was  added,  the  same  effects  were 
noted  in  a  still  greater  degree.  During  this  period  the  calories 
dropped  nearlj^  20^,  the  proteid  over  25;^,  and  the  flesh  foods  about 
'lOfo.  Comparing  the  diet  at  the  close  of  the  entire  five  months  of 
the  experiment  with  the  diet  at  its  beginning,  it  was  found  that  the 
total  calories  had  fallen  about  25^,  the  proteid  about  40^,  and  the 
flesh  foods  over  80;^,  or  to  about  one-sixth  of  their  original  amount. 
A  part  of  the  reduction,  at  least  of  the  calories,  is  probably  due  to 
the  change  in  season,  as  the  experiment  began  in  cold  weather  and 
closed  in  hot  weathei". 

These  results  are  shown  in  the  following  table  : 


J'^sher — 77ie  Ejf'ect  of  Diet  on  Endurance. 


TABLE  II. 

AVERAGE  DIETETIC  RECORDS  OF  ENTIRE  CLUB 

Average 

Calories 

Daily 

no.  of 

of  proteid 

"portions" 

Average 

"portions" 

per  lb.  of 

of  flesh 

Week 

weight 

daily 

body  wt.  ' 

foods 

fJan.  17-23 

149.8 

28.3 

2.7 

2.4 

!           24-30 

30.3 

2.6 

2.1 

31-Feb. 

6 

27.8 

2.5 

1.6    ■ 

Feb.    7-13 

27.0 

2.4 

1.2 

1st 

14-20 

25.8 

2.1 

.9 

'eriod '' 

21-27 

26.4 

2.2 

1.1 

28-Mar. 

6 

25.3 

2.2 

1.2 

\ 

Mar.   7-13 

24.6 

2.1 

1.3 

14-20 

25.9 

2.2 

1.1 

21-27 

148 

26.7 

2.2 

1.4 

^         28-Apr. 

3 

26.7 

2.1 

.8 

Apr.   4-10 

25.7 

1.9 

.5 

11-17'^ 

27.3 

1.7 

.4 

20-20  3 

26.1 

1.7 

.1 

2iul 

27-Mav 

3 

25.5 

1.9 

.5 

eriod ' 

Mav    4-10 

25.7 

1.9 

.4 

'  11-17 

26.2 

1.9 

.4 

18-24 

24.9 

1.7 

.4 

25-31 

22.2 

1.4 

.4 

,  June 

144 

Remembering  that  a  "portion  "  is  100  calories,  avg  see  that,  during 
the  first  four  weeks,  the  men  consumed  an  average  of  from  2760  to 
3030  calories  per  day,  of  which  120  to  240  were  in  the  flesh  foods, 
such  as  meats,  poultry,  fish  and  shell-fish,  and  that  2.4  to  2.7  calories 
of  proteid  Mere  ingested  for  each  pound  of  bod}'- weight.  Trans- 
lating Professor  Chittenden's  figures  for  the  physiological  require- 
ment of  ingested  proteid,  we  find"  it  to  be  from  1.3  to  1.7  calories  per 
]>ound  of  body-weight.  Thus  the  men  were  at  this  time  consuming 
nearly  double  the  Chittenden  allowance.  Durinof  the  last  four  weeks 
of  the  experiment  all  these  magnitudes  were  lower.  The  per  capita 
calories  ranged  from  2220  to  2620,  of  which  only  40  were  in  flesh 
foods,  and  the  proteid  had  fallen  to  1.4  to  1.9  calories  per  pound  of 
body-weight,  which  corresponds  closely  to  the  Chittenden  standard. 

Table  II  was  constructed  from  the  following  thi-ee  tables  giving 
separate  data  for  the  individual  experimenters. 


'  This  column  is  calculated  throughout  on  the  basis  of  the  body-weights  on 
Jan.  14. 

-Except  E.,  M.  and  P. 

'Except  E.  The  last  two  days  of  the  Easter  recess,  Apr.  18,  19,  are  omitted 
in  tables  11.  III.  IV,  V. 


Fisher — I'he  Effect  of  Diet  on  Endurance. 


TABLE  III. 
DAILY  QUANTITIES   OF  FOOD 

(in  "portions"  of  100  calories  each). 


Week 

B 

E 

Lq 

Lw 

M 

P 

E 

T 

W 

Averag 

Jan. 

19-23 

35.4 

26.1 

33.4 

33.6 

23.9 

27.0 

32.0 

36.1 

29.4 

28.3 

24-30 

27.9 

39.1 

34.3 

33.6 

36.8 

26.3 

84.5 

37.3 

33.9 

30.3 

31-Feb.  6 

26.3 

36.4 

35.0 

39.8 

24.4 

33.8 

30.9 

30.8 

33.0 

27.8 

1st 
Period " 

Feb. 

7-13 

25.7 

27.8 

35.7 

31.3 

23.0 

83.3 

38.0 

33.8 

31.6 

27.6 

14-20 

24.0 

33.4 

24.0 

36.1 

31.6 

30.3 

35.1 

39.2 

29.4 

25.8 

21-27 

23.0 

30.9 

23.4 

38.3 

34.5 

18.3 

26.7 

30.3 

32.2 

26.4 

28-Mar.  6 

23.3 

35.7 

23.6 

27.4 

24.1 

18.0 

25.4 

29.1 

30.8 

35.3 

Mar. 

7-13 

23.2 

33.0 

24.5 

27.4 

26.4 

19.3 

23.5 

23.7 

30.1 

34.6 

14-30 

21.9 

21.6 

24.5 

29.1 

30.2 

30.8 

25.0 

30.8 

28.9 

35.9 

21-37 

21.1 

34.3 

25.2 

31.6 

25.9 

21.2 

26.5 

34.4 

80.4 

36.7 

r 

28-Apr.  3 

33.6 

36.3 

26.2 

27.5 

25.2 

23.0 

26.1 

33.5 

30.2 

36.7 

Apr. 

4-10 

34.2 

24.2 

24.6 

27.7 

23.5 

22.5 

26.2 

30.5 

28.7 

25.7 

11-17 

24.0 

36.0 

24.9 

29.0 

30.4 

29.8 

27.31 

2nd 

20-36 

26.5 

24.1 

24.5 

23"6 

2:13' 

35.5 

32.0 

29.4 

26.1  ^ 

37-May  3 

25.5 

22.6" 

25.4 

24.8 

34.1 

24.4 

33.9 

29.0 

29.8 

35.5 

jreriOQ 

May 

4-10 

23.0 

25.5 

26.5 

24.4 

37.1 

23.1 

26.0 

28.7 

26.7 

35.7 

11-17 

21.8 

19.3 

26.5 

27.6 

34.5 

23.8 

37.6 

30.3 

34.2 

36.3 

18-24 

32.7 

19.1 

33.7 

27.8 

19.5 

25.4 

34.6 

26.5 

35.2 

34.9 

^ 

35-31 

19.3 

17.2 

33.6 

27.1 

17.8 

21.9 

34.3 

20.3 

28.6 

22.2 

From  this  table  we  see  that  there  were  wide  differences  between 
the  men  in  regard  to  the  change  in  the  quantity  of  food.  During 
the  first  period  the  men  who  reduced  their  calories  conspicuously 
were  B.,  P.  and  R.,  the  very  men,  as  Table  IX  will  show,  who  lost 
weight  during  this  period. 

During  the  second  period,  reductions  were  noticeable  in  E.,  Lw.,  M. 
and  T.  These,  together  with  B.  and  P.,  were  the  men  who  lost 
weight  during  the  second  period.  We  see  here  a  distinct  correlation 
between  quantity  of  food  and  loss  of  body-weight. 


TABLE  IV. 
PROTEID  (in  calories)  PER   LB.  OF  BODY-WEIGHT 


(Body-weiglit  as  taken  Jan.  14,  1906) 


Week 
f Jan.  17-23 


.  1st      , 
Period  ' 


Feb. 


Mar. 


24-30 
31-Feb.  6 

7-13 
14-20 
21-27 
28-Mar.  8 

7-13 
14-20 
21-27 


B        E      Lq     Lw     M 


2.6 

2.5 
2.2 
2.1 
3.0 
1.8 
1.8 
1.9 
1.9 
1.6 


2.9 

2.8 
3.1 
3.9 
3.1 
3.3 
3.0 
3.5 
3.3 
3.6 


1.8 
2.2 
2.4 
2.2 
1.8 
1.9 
1.8 
2.0 
1.9 
2.0 


2.8 
2.8 
2.9 
2.6 
2.0 
2.3 
2.3 
3.3 
2.5 
2.7 


3.6 

3.7 
3.5 
2.0 
1.9 
2.0 
2.4 
2.5 
2.7 
2.4 


2.8 
2.5 
2.0 
2.1 
1.7 
1,5 
1.5 
1.7 
1.7 
1.7 


R 

2.5 
2.5 
2.8 
2.0 

1.8 
1.9 
1.8 
1.7 
1.9 
1.9 


3.3 
3.0 

3.7 
2.9 
3.7 
3.8 
3.6 
3.1 
3.8 
':>  7 


W 

3.7 
3.8 
3.6 
2.6 
2.2 
2.4 
2.4 
2.6 
2.4 

9,  9, 


Average 

2.7 
2.6 
2.5 
2.4 
2.1 
2.2 
3.3 
2.1 
2.2 
2.3 


Not  including  E.,  M.  and  P. 

"  "         E. 


Fisher —  The  J^ffect  of  Dkt  on  JEndurance. 

TABLE  lY—Coniinued. 

PROTEID  (in  calories)  PER  LB.   OF  BODY-WEIGHT 

(Body-weight  as  taken  Jan.   14.   1006) 


Week 

B 

E 

Lq 

L\v 

M 

1' 

R 

T 

W 

Average 

■^Mar.  28- Apr.  :3 

1.8 

2.6 

2.0 

2.2 

.■V  .   .W 

l.!» 

1.8 

2.7 

O   0 

2.1 

Apr.     4-10 

1.5 

2.!) 

1.7 

2.0 

1.7 

1.5 

1.8 

2.4 

1.8 

1.9 

11-17 

1.3 

1.8 

1.7 

1.7 

1.9 

1.9 

1. 1 

20-'2(! 

1.8 

1.6 

1.6 

1.7 

1.5 

1.5 

2.3 

1.6 

J .  t 

27-Mav;3 

1.7 

2.5 

1.7 

1.7 

2.0 

1.7 

1.6 

2.3 

1.8 

1.9 

Mav     4-10 

1.6 

3.0 

1.9 

1.9 

2.2 

1.4 

1.8 

2.1 

1.5 

1.9 

11-17 

1.6 

1.9 

1,7 

1.9 

1.9 

1.6 

1.9 

2.1 

2.0 

1.9 

18-24 

1.5 

1.8 

1.4 

1.7 

1.8 

1.6 

1.6 

1.7 

2.1 

1  .  I 

2n(l 
Periud 


25-31  1.1     1.3     1.5     1.6     1.6     1.3     1.7     1.4     1.5         1.4 

We  observe  from  Table  IV  that  the  men  who  reduced  their  proteid 
the  most  during  the  first  period  were  B.,  P.,  R.,  T.  and  W.  Of  these 
the  first  three  only  lost  weight  appreciably,  and  this  was  partly  ascrib- 
able,  as  we  have  seen,  to  reduction  in  their  calories.  Careful 
examination  of  the  figures  would  seem  to  show,  however,  that  there  is 
some  correlation  between  reduction  of  proteid  and  loss  of  weight. 

During  the  second  period  there  was  a  decided  reduction  of  proteid 
in  all  cases  except  that  of  R.,  who  had  already  brought  his  proteid 
down  considerabl}"  in  the  first  period.  E.  reduced  his  proteid,  but  not 
until  the  last  three  weelis,  when  he  seemed  to  try  to  make  up  for  lost 
time.  E.,  in  fact,  was  the  only  man  in. the  club,  except  possibly  M. 
who  (through  mere  inadvertence)  did  not  follow  out  the  rules  of  the 
experiment  systematically.  It  need  scarcely  be  said  that  this  is  not 
stated  as  censure  ;  for  the  very  fact.of  the  moderation  of  E.'s  and  M.'s 
mastication  added  to  the  value  of  the  final  comparisons.  Even  E.'s 
sudden  reduction  in  proteid  at  the  end  was  not  maintained  two  weeks 
afterward,  as  was  shown  by  the  excretion  of  nitrogen  in  June, 
given  in  Table  VI, 

It  will  be  observed  that  the  proteid  at  the  end  of  the  experiment 
was  reduced  to  a  fairly  uniform  level  for  all  the  men.  Moreover,  the 
proteid  at  the  end  corresj)onds  closely  with  the  results  of  Professor 
Chittenden's  experiments.  This  is  especially  significant  in  view  of 
the  fact  that  this  level  was  I'eached  unconsciously  — for  only  one  of 
the  men,  Lq.,  who  used  the  mechanical  diet  indicator  for  the  entire 
club,  knew  regularly  the  exact  character  of  each  man's  food  propor- 
tions— and  without  an^^  food  prescription  as  was  employed  in  the 
ex[)eriments  of  Professor  Chittenden.  This  means  that  there  is  a 
simple  way  of  reducing  proteid  to  the  level  of  "  physio  logical  econ- 


10  FlsJier—TJie  Effect  of  Diet  on  Endurance. 

omy,"  open  to  the  ordinary  man,  v/ithout  the  necessity  of  special 
knowledge  of  foods  and  without  the  necessity  of  weighing  and  measur- 
ing food,  either  by  the  subject  himself  or  by  others. 

Aside  from  the  changes  in  proteid,  the  proportions  of  food  elements 
did  not  vary  greatly,  the  percentages  of  fat  and  carbohydrate  in  the 
total  fuel  value  remaining  very  nearly  constant.  At  the  close  of  the 
experiment  it  was  found  that  for  all  of  the  men  the  proteid  in  propor- 
tion to  the  total  fuel  value  was  very  nearly  10^,  having  been  reduced 
from  about  14^.  This  reduction  in  the  percentage  of  proteid  was 
almost  entirel}^  offset  by  the  increase  in  the  percentage  of  fat,  which 
rose  from  about  30^  to  about  33^  on  the  average.  The  percentage 
of  carbohydrate  thus  remained  almost  constant.  Individual  varia- 
tions were  much  less  than  might  have  been  expected.  The  proteid 
at  the  close  of  the  experiment  among  the  diiferent  subjects  deviated 
very  little  from  lO'/o  ;  the  proportion  of  fat  varied  from  28  to  36^j 
and  the  carbohydrate  from  51  to  62^. 

The  results  of  the  experiment  may  throw  some  light  on  the 
problem  of  the  proper  amount  of  food  and  food  constituents  for 
healthy  men  eating  in  a  natural  manner.  For  the  five  men,  Lq.,  Lw.> 
M.,  R.  and  W.,  whose  weights  showed  least  tendency  to  fall  and 
whose  average  weight  at  the  close  of  the  experiment  was  151.4,  we 
find  the  average  total  calories  were  2G20,  of  which  10.7^  was  proteid, 
83^  fat,  and  56.3^^  carbohydrate.  The  number  of  calories  agrees 
closely  with  the  estimates  (for  sedentary  persons)  of  Atwater  and 
Benedict  by  means  of  the  calorimeter. 

TABLE  V. 

QUANTITIES   OF  FLESH  FOODS  CONSUMED  (meat,  fish, 

shell-fish;  poultry) 

(In  "portions"  of  100  calories  each). 


1st 
Period  ^ 


Week 

B 

E 

Lq 

Lw 

M 

P 

R 

T 

W  Average 

f  Jan.  17-23 

2.7 

2.4 

1.5 

2.6 

2.4 

2.6 

2.3 

2.9 

2.1 

2.4 

24-30 

2.2 

2.2 

1.7 

2.0 

1.8 

2.2 

2.1 

2.1 

2.2 

2.1 

31-Feb.  6 

1.3 

1.9 

1.2 

2.1 

1.6 

1.3 

2.1 

1.9 

1.4 

1.6 

Feb.    7-13 

1.3 

1.6 

.9 

1.7 

.6 

1.2 

1.5 

1.8 

1.2 

1.2 

14-20 

.9 

2.3 

.2 

1.1 

rr 

.9 

.9 

1.6 

.5 

.9 

21-27 

1.2 

2.0 

.2 

1.6 

.6 

1.6 

2.1 

.6 

1.1 

28-Mar.  6 

.8 

2.1 

!3 

1.5 

1.1 

1.1 

1.6 

1.5 

.8 

1.2 

Mar.    7-13 

I*' 
.  i 

1.6 

.1 

2.4 

1.0 

1.2 

1.9 

1.6 

.9 

1.3 

14-20 

1.0 

1.7 

.03 

1.9 

.9 

1.8 

1.5 

.7 

1.1 

21-27 

1.0 

2.5 

.0 

2.5 

1.7 

.7- 

1.2 

2.5 

.6 

1.4 

Fisher — 7'he  Ejf'ect  of  Diet  on  Endurance.  11 

TABLE  Y— Continued. 
QUANTITIES   OF   FLESH   FOODS   CONSUMED  (meat,  fish, 

shell-fish,  poultrj-) 
(In  "portions"  of  100  calories  each). 


Week 

B 

E 

L,i 

Lw 

M 

P 

R 

T 

W 

Aver 

Mar. 

28-Apr.  :l 

.9 

1.7 

.0 

1.7 

.6 

.8 

1.1 

.s 

.1 

.8 

Apr. 

4-10 

.4 

1.1 

.0 

1.0 

1.0 

.1 

.8 

.0 

.5 

11-17 

.1 

.0 

.9 

.8 

.  1 

.0 

.4 

20-26 

.0 

.0 

.1 

"i 

"o 

.2 

.4 

.0 

.1 

2r-Mav  :} 

.16 

L2 

.0 

.6 

.8 

.2 

.9 

.5 

.0 

.5 

May 

4-10  ■ 

.0 

.9 

.0 

.8 

.8 

.0 

.5 

,6 

.0 

.4 

11-17 

.0 

1.2 

.0 

.  I 

.8 

.0 

.4 

.3 

.0 

.4 

18-24 

.0 

i.;{ 

.0 

.■) 

.i) 

.0 

.8 

.2 

.0 

.4 

2ucl 
Period 


25-31  .0    1.0      .0    1.0      .9      .0      .8      .4      .0        .4 

Table  V  shows  that  during  the  first  period  all  except  E.  and  Lw. 
reduced  their  consumption  of  fiesh  foods  considerably.  It  is  note- 
worthy, as  Tables  XI-XIII  will  show,  that  these  two  were  the  men 
whose  improvements  in  endurance  were  probably  among  the  least 
during  this  period. 

During  the  second  period  Lq.,  W.,  P.  and  B.  virtually  abandoned 
fiesh  foods  entirely,  the  "  portions  "  consumed  daily  averaging  nearer 
zero  than  .1.  These  men  improved  greatly  in  endurance  also.  On 
the  other  hand,  E.,  Lw.,  M.  and  R.  reduced  their  flesh  foods  the 
least,  and  their  ranking  in  respect  to  increased  endurance  was  in 
general  relatively  low. 

Excretions,    Body-  Weight,    Strength. 

The  following  table  of  nitrogen  excreted  in  the  urine  is  interesting 
in  connection  with  the  preceding  table.  It  will  be  seen  that  the 
reduction  in  nitrogen  daily  excreted  corresponds  in  general  to  the 
reduction  in  proteid  consumed. 


TABLE 

VI. 

GRAMS 

,  OF 

NITROGEN  EXCRETED  DAILY. • 

B 

E 

Lq         Lw 

M 

P 

R 

T 

W 

Mid.Ue  Jan.       10.4 

12.7 

14.3       14.3 

8.7  = 

11.1 

14.8 

12.2 

15.4 

First  April          6.6 

14.7 

9.2       11.1 

6.3 

11.0 

12.4 

9.0 

Middle  June       6.:J 

13.1 

8.4 

13".  7 

6.1 

\ 

8.8 

9.4 

N.  in  middle"! 

June  per          !          q,... 
kilog.  of          ;         -^''^ 

.22 

.12      ... 

.21 

.09 

— 

.12 

.13 

body-weight  J 

'  Each  figure  is  obtained  by  averaging  2  or  3  consecutive  days'  specimens. 
2  Jan.  23  and  Feb.  10. 


12  Fisher— The  Effect  of  Diet  on  Endurance. 

This  table  shows  that  all  the  men  excepting  E.  and  M,  greatly 
reduced  their  nitrogen  excretion  dnring  the  experiment,  and  that  at 
the  close  (with  the  two  exceptions  noted)  the  men  were  on  about  the 
same  nitrogen  level  as  the  subjects  of  Professor  Chittenden's  exper- 
iment, namely,  near  one-tenth  of  a  gram  of  nitrogen  per  kilogram  of 
body- weight. 

Through  the  kindness  of  Professor  Benedict  of  Wesleyan  Univer- 
sity, nitrogen  analyses  were  made  in  December,  1906,  six  months 
after  the  close  of  the  experiment,  to  discover  to  what  extent  the  men 
had  adhered  to  their  newly  acquired  diet  after  the  eating  club  in 
which  it  had  been  practiced  was  disbanded.  The  results  were  B. 
11.0,  Lq.  10.5,  Lw.  7.9,  M.  9.9,  P.  6.8,  R.  11.5,  T.  11.9,  W.  8.9.  These  ■ 
show  that  half  of  the  men  had  reverted  to  some  extent  toward  their 
original  diets.  The  men  stale  that  the  reason  for  this  reversion  was 
the  difficulty  in  selecting  food  differing  greatly  in  kind  and  amount 
from  that  customarilv  served  at  their  boarding  houses. 

The  following  table  shows  that  the  volume  of  urine  dailv  excreted 
was  greatly  reduced  during  the  experiment  : 

TABLE  VII. 
VOLUME  OF  URINE  DAILY  EXGEETED   (in  cubic  centimeters) 

B  E*       Lq         Lw  M  P  R  T  W 

Middle  Jan.  1425  1160  1180  l;;91  817^  706  1387  1792  1177 
First  April  630  985  900  1252  ..._  629  1025  930  797 
Middle  June      802       1120        822       785        480       696        970 

From  this  table  we  see  a  striking  reduction  in  the  volume  of  urine 
excreted,  with  the  same  two  notable  exceptions,  E.  and  M.  These 
two,  who  reduced  their  excretions  lea§t,  were  the  men  who  Avere  the 
least  assiduous  in  observing  the  rules  of  the  experiment. 

A  careful  examination  of  the  feces  was  made  hj  Professor  L.  F. 
Rettger  of  the  Sheffield  Scientific  School.  A  summary  of  his  report 
follows.  In  it  was  included  a  comparative  statement  for  three  sets 
of  specimens  of  two  days  each,  taken  in  January,  March  and  June, 
referred  to  below  as  series  I,  II  and  III.  These  included  data  as  to 
the  color,  odor,  quantity,  consistency,  approximate  determination  of 
the  number  and  predominant  kinds  of  bacteria,  putrefactive  and 
fermentative  properties,  and  a  true  microscopic  bacterial  examination. 
In  brief,  to  quote  from  Dr.  Rettger's  report  and  letter : 

'  Jan.  23  and  Feb.  10. 


Fisher — T/ie  Ejf'ect  of  l)ht  on  Endurance.  13 

"  The  odor  was  very  slii^^ht  in  almost  every  specimen  in  the  last 
series,  a  marked  difference  between  tliese  and  series  I  and  II, 
](articularly  I.     Tlie  average  weight  is  less  than  in  both  series  I  and 

II  (av.   wt,    of    series   1=  137.3    grams;  of  II  =  1G4.8    grams,    and 

III  =  120.4  grams). 

"The  Hgures  indicate  considerable  different'  in  the  putrefactive  and 
fermentative  properties  of  the  three  series,  and  the  decrease  is  progi-es- 
sive.  In  series  I  the  amount  of  proteid  dissolved  was  mucli  larger 
than  in  II  and  III.  .  .  The  specimens  [of  series  III]  were  more 
solid  generally  than  in  both  })revious  scries.  I  was  unable  to  note 
any  apj»reciabk'  difference  in  the  microscopic  a])pearance  of  the  last 
series  as  compared  with  the  previous,  except  that  in  specimen  B  of 
the  last  series  a  large  number  of  moulds  were  present.  This  has  little 
significance,  however." 

TABLE  Till.     FECAL  TESTS  ' 
Putrefactive  Deuree  Fermentative  Propertt 


Mid. 

End 

Mid. 

Mid. 

End 

Mid. 

Jan. 

March 

June 

Jail. 

March 

June 

B 

f 

i 

8.'? 

+  + 

+ 

+ 

E 

^0% 

35^ 

1Q% 

+  + 

+ 

+ 

M 

2% 

10% 

\5% 

+ 

+ 

+ 

Lq 

00,'j; 

« 

50<^ 

+  + 

+ 

+ 

Lw 

2o% 

15^ 

+ 

+  + 

+ 

+ 

P 

20t; 

1 

« 

+ 

— 

— 

R 

m% 

2Q%  ' 

t 

+  + 

+ 

t 

T 

20ri 

? 

0% 

? 

+ 

+ 

W 

30$^ 

10^ 

0% 

+  + 

+ 

+ 

We  here  observe  that  the  degree  of  putrefaction  in  the  last  two 
tests  was  usually  considerably  less  than  its  magnitude  in  the  first 
test.  The  least  change  in  the  feces  occurred  in  the  cases  of  Lq.,  M. 
and  E.,  and  the  greatest  changes  in  P.,  T.  and  W.  Here  again  we 
find  some  correspondence  between  the  assiduity  of  the  men  and  the 
observed  phj^siological  changes  ;  for  E.  and  M.  were  the  least  and  P. 
and  W.  the  most  careful  among  the  experimenters. 

A  critic  has  raised  the  question  whether  the  improvement  in  the 
feces  indicates  lessened  absorption  of  poi.sons,  and  whether,  if  the 
feces  were  longer  retained,  the  imj^rovement  in  their  character  might 
not  be  in  consequence  of  the  abstraction  from  them  and  absorption 

'  In  the  table,  "  +  "  signifies  the  presence  and  *'  —  "  the  absence  of  fermenta- 
tive property  ;  "  +  +  "  represents  a  high  degree  of  fermentative  property  ;  "  ?" 
signifies  that  the  putrefactive  degree  was  doubtful,  if  not  absent. 

fNo  specimen. 


14  Fisher — The  Effect  of  Diet  on  JEn durance. 

into  the  system  of  a  larger  amount  of  poisons.  The  length  of  time  of 
retention  of  the  feces  was  not  measured  in  any  way.  So  far  as  can  be 
guessed  from  the  impressions  of  the  men,  it  was  not  lengthened,  cer- 
tainly not  greatly,  as  in  the  case  of  Mr.  Fletcher. '  As  to  the  sig- 
nificance of  the  improvement  in  feces,  Dr.  Rettger  writes  : 

"  The  subject  of  intestinal  putrefaction  is  one  of  which  very  little 
is  as  yet  known.  A  retention  of  feces  may  have  the  tendency  of 
lowering  the  amount  of  putrefactive  products.  This  is  due,  I  believe, 
to  two  things  :  first,  an  absorption  of  such  products  as  indol  and 
mercaptan  ;  and  second,  an  unusual  amount  of  antagonistic  action 
exerted  on  the  evil-producing  (])utrefactive)  bacteria  by  the  ordinary 
and  presumably  helpful  bacteria.  Recent  work  seems  strongly  to 
emphasize  the  latter  point.  .  .  There  is  nothing  to  show  that  a 
small  degree  of  retention  would  make  a  very  "great  difference. 

"  The  absence  of  appreciable  amounts  of  jjutrefactive  bodies  from 
feces  under  the  ordinar}^  conditions  of  peristalsis  does,  beyond  a 
doubt,  indicate  a  lessened  jjroduction  of  the  products  (toxines)  ;  the 
system  must  be  the  better  off  on  account  of  this  .  .  .  the  inter- 
pretation of  the  facts  must  be  dealt  with  rather  cautiously." 

The  following  table  shows  the  body-weights  of  the  men  (after 
deducting  weight  of  clothing). 

TABLE  IX. 
BODY-WEIGHTS  IN  POUNDS  (without  clothing) 

B  E        Lq       Lw        M         P  R  T         W        Average 

Jan.  14      148       127       147      153       141       144       179       156       153  149.8 

Mar.  28       144       128       147      154       142       136       176       155       151  148 

June  16       138       122       146       149       138       131       175       148       149  144 

We  see  that  during  the  first  period,  the  weights,  except  of  P., 
remained  practically  stationary,  but  that  in  the  second  period  all  of 
the  men  lost  somewhat  in  weight,  though  the  loss  was  trifling  in  most 
cases.  The  only  substantial  losses  during  the  two  periods  combined 
were  :  P.  13  lbs.,  B,  10  lbs.,  and  T.  8  lbs.  Of  these  it  may  be  said 
that  B.  was  distinctly  over  his  normal  weight  at  the  start. 

The  distinct  correlation  between  the  loss  of  weight  and  the  reduction 
in  food,  and  to  some  extent  in  proteid,  has  already  been  noted.  P.'s 
loss  is  ascribable  largely  to  overstudy.  The  general  slight  reduction 
in  weight  of  the  entire  club  is  probably  explained  in  the  same  way, 
for  all  the  men,  with  possibly  two  exceptions,  distinctly  overstrained 

'  See  The  A.  B.-Z.  of  our  own  Nutrition. 


Fisher — 7Vie  Effect  of  Diet  on  Endurance. 


15 


ill  their  college  work.  Besides  the  iiittuence  of  overwork,  there  was 
also  present  the  iiirtiience  of  the  season, — at  least  if  the  connnon 
impression  is  correct  that  persons  usually  lose  weij^ht  with  the 
approach  of  warm  weather. 

Gymnasium  tests  were  made  at  the  beginning',  middle  and  end  of 
the  experiment.  These  tests  were  of  two  kinds, — tests  of  strength 
and  tests  of  endurance.  The  times  of  the  tests  were  widely  separated, 
partly  because  those  of  endurance  were  too  exhausting  to  be  often 
repeated,  and  partly  because  it  was  desired  to  avoid  the  influence  of 
'' j)ractice "  ;  for  not  only  does  practice  increase  strength  and  en- 
durance, but  it  also  gives  the  users  of  the  strength-registering 
apparatus  a  facility  or  "knack"  in  manipulating  it  which  produces 
a  false  appearance  of  improvement. 

The  dates  of  the  three  tests  wei'e  January  14,  a  week  after  the  end 
of  the  Christmas  vacation  ;  March  28,  just  before  the  Easter  recess  ; 
and  June  10, '  just  before  the  summer  vacation. 

Tests  of  strength,  taken  at  the  beginning,  middle  and  end  of  the 
\experiment,  show  the  following  effects  : 


Date 

(  Jau.   14 

R.   Grip       -  ilch.  28 

(  Jim.   16 

(  Jan.   14 

L.  Grip      -  Mch.  28 

(  Jnu.   16 

(  Jan.   14 

Back  Lift  -  Mch.  28 

(  Jun 


16 


Leg  Lift 


Total 


(  Jan.    14 

-  Mch.  28 
(   Jun.   16 

(   Jan.   14 

-  Mch.  28 
(  Jun.  16 


TABLE  X. 
STRENGTH  TESTS  (in  lbs.) 


BE  Lq  Lw  M 

100     185  95  98  145 

93  180  110  100  112 
91     130  110  92  105 

94  115  83  112  107 
82  115  110  100  105 
75     115  97  105  105 

275    400  280  310  375 

260    440  375  380  275 

280     300  290  250  330 

520     600  370  400  460 

515     600  455  450  410 

400     545  440  445  400 

989  1250  827  050  1087 

950  1285  1050  1030  902 

846  1090  937  892  940 


P 

95 
102 
103 


R  T  W    Average 

132  120  125         116 

127  130  117         113 

125  121  115         110 


82     131       95     127  105 

70     115     106     111  102 

70     125      98     110  100 

250     360     370     365  835 

275    390    400    400  355 

265    345     330    364  306 

820     820     545     635  519 

415    865    570    650  548 

300     610     520     650  479 

747  1443  1180  1252  1075 

862  1497  1206  1278  1118 

788  1205  ]()<)!»  1239  995 


In  this  table  we  see  that  during  the  first  period  there  was  a  slight 
increase  in  strength  (from  an  average  "total"  strength  of  1076  to 
1118),  and  during  the  second  period  a  slight  fall  to  995,  which  is 
about  12^  from  the  mid-yeai''s  1118,  and  about  8^  from  the  original 


'  But  May  31  for  E.,  Lw. ,  R.  and  W. ,  on  account  of  earlier  examinations  than 
the  others,  necessity  to  leave  town,  etc. 


16  Fisher — The  Effect  of  Diet  on  Endurance. 

1076.  Thus  the  strength  of  the  men  remained  nearl}^  stationary 
throughout  the  experiment.  The  greatest  losses  were  those  of  B.,  E. 
and  R.,  whose  records  fell  respectively  from  989  to  846,  1250  to 
1090,  and  1443  to  1205. 

The  loss  of  strength,  like  the  loss  of  weight,  seems  most  jjrobably 
explainable  by  the  overstudy  of  the  men.  This  cause  was  certainly  act- 
ively at  work,  and  would  apply  in  the  case  of  all  of  the  club  with  possi- 
bly two  exceptions.  Overstudy  applied  conspicuously  to  B.  and  R., 
both  of  whom  not  onlj^  overworked  during  the  entire  period  of  the 
experiment,  but  had,  just  before  coming  to  the  last  test,  been  through 
the  most  exhausting  and  sleep-robbing  week  of  all.  There  seems, 
therefore,  little  reason  to  ascribe  any  part  of  the  slight  losses  of 
strength  to  the  dietetic  experiment  itself. 

This  opinion  is  confirmed  by  two  facts  :  One  is  that  the  man  who 
w'as  least  affected  dietetically  by  the  experiment  was  E.,  one  of 
the  three  largest  losers  of  strength,  while  the  men  who  were  most 
affected  dietetically  were  P.  and  W.,  neither  of  whom  lost  strength 
perceptibly,  in  spite  of  P.'s  severe  overwork  and  loss  of  Aveight.  The 
other  fact  is  that  in  Professor  Chittenden's  experiment,  which  dietet- 
ically was  very  similar,  the  subjects,  who  were  soldiers  and  athletes 
and  not  subject  to  pressure  of  work  of  any  kind,  showed  large  gains 
in  strength.  F'rom  these  two  facts  we  may  infer  that,  so  far  as  the 
diet  is  concerned,  the  effect  would  be  to  increase  rather  than  to 
decrease  strength. 

Changes  in  Physical  Endurance. 

It  is  fortunate  that  the  strength  of  the  men  remained  so  nearly 
stationary  ;  for  it  demonstrates  the  more  clearly  that  the  increase 
in  endurance  which  will  be  shown  below  was  an  increase  in  endur- 
ance per  se,  and  not  in  any  degree  due  to  an  increase  in  strength. 
Strength  and  endurance  are  entirely  distinct  and  should  be  separately 
measured.  The  strength  of  a  muscle  is  measured  by  the  utmost  force 
which  it  can  exert  o?ice  ;  its  endurance,  by  the  number  of  times  it 
can  repeat  a  given  exertion  well  loithin  its  strength. 

After  much  consideration  and  consultation  it  was  decided  not  to 
place  reliance  on  the  ordinary  ergographs  as  a  means  of  measuring 
endurance.'    Instead,  seven  simple  gymnastic  tests  of  physical  endur- 

^  The  reasons,  in  brief,  were  (1)  iDecanse  these  ergographs  are  adapted  to  testing 
only  a  few  unimportant,  and  for  the  most  part  unused,  muscles  ;  (3)  because,  in 
operating  these  devices,  the  subjects  do  not  simulate  real  work,  since  the  mtis- 


Fisher — 21ie  Jijfect  of  Diet  on,  Endurance.  IT 

anee  were  employed,  and  one  of  mental  endurance.  The  seven  phys- 
ical tests  were  : 

(1)     Rising  on   the  toes  as  many  times  as  possil)le. 

[•2)     Deep  knee-bending,  or  squatting  as  far  as  possible  and  rising  to 

the  standing  posture,  repeating  as  often  as  possible. 
{.;)     ^Vhile  lying  on  the  back,  raising  tlic  legs  from  the  floor  to  a 

vertical  position  and  lowering  them  again,  repeating  to  the 

point  of  ])hysical  exhaustion. 
(4)     Raising  a  5-lb.  dumb-bell  (with  the  triceps)  in  each  hand  from 

the  shoulder  up  to  the  highest  point  above  the  head,  repeating 

to  the  point  of  physical  exhaustion, 
(o)     Holding  the  arms  from  the  sides  horizontally  for  as  long  a  time 

as  possible. 

(6)  Raising  a  dumb-bell  (with  the  bicei^s)  in  one  hand  from  a  position 

in  which  the  arm  hangs  down,  up  to  the  shoulder  and  lower- 
ing it  again,  repeating  the  motion  to  the  point  of  physical 
exhaustion.  This  test  was  taken  with  four  successive  dumb- 
bells of  decreasing  weight,  viz.,  50,  25, 10  and  5  lbs.  respectively. 

(7)  Running  on  the  gvmnasium  track  at  a  speed  to  suit  the  subject, 

to  as  great  a  distance  as  possible. 

The  mental  test  consisted  of  adding  specified  columns  of  figures 
as  rapidly  as  possible,  the  object  being  to  find  out  whether  the 
rapidity  of  performing  such  Avork  tended  to  improve  during  the 
experiment. 

From  the  Avisdom  born  of  experience  it  may  be  stated  that  the 
physical  tests  were  too  numerous  and  too  severe.     But  after   they 

eles  are  placed  in  an  awkward  and  unnatural  position  in  which  "  no  purchase  " 
is  felt  ;  (3)  because  experience  has  shown  that  subjects  waste  their  efPort  by 
expending  it  not  only  while  raising  but  while  lowering  the  weight,  and  that  this 
waste  during  the  period  of  relaxation  varies  gi-eatly  with  different  subjects  ;  (4) 
because  a  fixed  weight  is  used  instead  of  a  weight  proijortionate  to  the  different 
strengths  of  the  various  siibjects.  One  might  as  well  attempt  to  test  the  walk- 
ing powers  of  a  woman  weighing  100  lbs.,  as  compared  with  those  of  a  man  weigh- 
ing 200  lbs.,  by  compelling  the  woman  to  carry  a  100-lb.  weight  so  that  she 
might  walk  with  the  same  weight  as  the  man.  Some  of  these  objections  have 
been  met  in  special  instruments,  such  as  that  of  Prof.  W.  S.  Hall  of  Northwest- 
ern University. 

After  the  experiment  was  half  over,  and  too  late  to  make  use  of  it,  the  writer 
devised  an  ergograph  which,  it  is  believed,  meets  all  of  the  above  objections. 
He  was  led  to  do  so  by  the  fact  that  the  tests  employed  w^ere  so  frightfully 
exhausting  to  the  men.  A  description  of  the  new  ergograjih  will  be  piiblished 
later.     It  is  to  be  employed  in  further  tests. 

Trans.  Conx.  Acad.,  Vol.  XIII.  2  May,  1907. 


18  Fisher — The  Effect  of  Diet  on  Endurance. 

were  once  adopted  in  January,  it  was  necessary  in  subsequent  tests 
to  adhere  to  them,  so  far  at  least  as  always  to  begin  with  the  same 
test  and  follow  the  same  sequence  of  tests  as  far  as  the  series  was 
repeated.  It  is  clear  that  one's  ability  to  succeed  in  an  individual 
test  would  depend  greatly  on  what  and  how  many  tests  had  immedi- 
ately preceded  ;  consequently  the  o\\\j  modifications  in  the  January 
tests  which  could  legitimately  be  adopted  in  JMarch  consisted  in  omit- 
ting all  tests  after  the  first  two  or  three.  These  first  two  or  three, 
being  taken  under  the  same  conditions  as  before,  reflected  correctly 
an}^  change  in  endurance  so  far  as  those  particular  tests  were  con- 
cerned. 

At  the  final  series  of  tests  in  June,  no  omissions  from  the  January 
program  were  made  ;  to  save  time,  however,  the  last  two  parts  of 
test  6,  together  with  test  7  (which  came  at  the  end  for  all  the  men), 
w^ere  repeated  only  up  to  the  point  at  which  they  had  been  carried  in 
January,  although  the  men  were  able  in  June  to  carry  them  much 
further,  and  in  many  cases  did  so  of  their  own  accord.  One  man,  for 
instance  (W.),  who  in  the  run  in  January  was  glad  to  stop  at  10 
laps,  went  on  in  June  to  34,  running  at  the  same  speed  until  near 
the  end  ;  and  this  was  done  after  having  more  than  doubled  his 
former  records  in  almost  all  of  the  other  tests.  The  unlooked-for 
increase  in  endurance  made  the  June  tests  much  more  time-consuming: 
than  the  tests  in  January  and  March.  Had  the  men  in  June  taken 
test  7,  and  the  two  last  parts  of  test  6  up  to  the  same  fatigue  limit 
as  in  January,  some  of  them  would  have  had  to  remain  in  the  gym- 
nasium (supperless)  until  bed  time.  One  of  the  men,  who  in  January 
in  the  last  two  parts  of  test  6  raised  the  10-lb.  dumb-bells  318  times 
and  the  5-lb.  dumb-bells  1,863  times,  without  doubt  could  have  raised 
them  in  June  double  and  probably  treble  these  numbers,  but  to  have 
done  so  would  have  consumed  of  itself  an  hour  and  a  half  of  extra 
time. 

In  view,  therefore,  of  the  only  partial  repetition  of  test  7  and  the 
last  two  parts  of  test  6,  these  records  are  omitted  from  Table  XI. 
The  first  part  of  test  6  (lifting  the  50-lb.  dumb-bell)  is  also  omitted, 
being  given  separately  below. 

The  following  table  (XI)  shows  the  results  of  the  three  sets  of  tests 
in  January,  March  and  June. '     This  table  will  repay  careful  study. 


•^  The  order  in  which  tlie  tests  were  taken  was  not  the  same  for  all  of  the  nine 
men,  owing  to  the  lack  of  a  sufficient  number  of  gymnasium  assistants  in  taking 
the  tests.  But  care  was  taken  that  each  man  should  himself  i^reserve  the  same 
order  in  all  three  series  of  tests.     Thus,  for  the  March  series  he  took  the  first  two 


Fisher — 77t<j  E^'ect  of  Diet  on  Endurance.  1!) 

From  it  we  see  tliat  witli  one  exception  (K.)  all  of  the  men  had  im- 
proved in  the  3Iart'h  and  June  tests  as  compared  witli  the  .lanuary 
tests,  and  the  eight  men  who  did  improve  showed  iini»rovement  in 
every  test,  exee|)t  L(].,  Lw.  and  T.,  who  sliowed  slight  falling  off  in 
iiulividnal  cases. 

As  inspection  will  show,  some  of  the  increases  are  remarkable. 
The  recorded  increases  in  the  60  odd  cases  were,  Avith  a  few  excep- 
tions noted  below,  all  true  increases  and  not  due  to  increased  effort 
to  break  a  previous  record.  In  anticipation  of  such  possible  effect 
of  ambition,  the  men  were  urged  in  the  Januar}'^  tests  to  the  utmost 
limit  the}'  could  or  would  stand.  The  origiijal  intention  had  been  to 
work  each  muscle  tested  until  it  was  plij^sically  unable  to  repeat  the 
motion,  but  this  was  not  usually  found'practicable,  except  in  tests  3,  4 
and  6,  and  in  some  cases  2.  In  the  other  tests  the  Avill  gave  out  before 
the  muscles.  The  ]\[arch  and  June  tests  were  so  managed  that  when 
a  man  had  surpassed  his  January  record  he  was  not  allowed  to  pro- 
ceed beyond  the  degree  of  fatigue  which  he  had  reached  in  the  first 
test.  Tliis  was  usually  not  a  difficult  matter,  as  the  fatigue  in 
January  had  been  excessive  and  the  men  had  no  desire  to  suffer 
again  the  painful  after-effects.  Hence,  with  the  exceptions  to  be 
noted,  the  March  and  June  records  not  only  exceeded  those  of  Jan- 
uary, but  were  accomplished  with  much  less  fatigue.  The  actual 
improvement  was  therefore  greater  than  the  recorded  impi'ovement. 

oi'  three  tests  which  he  had  taken  in  January.  This  explains  why,  in  the  March 
series,  the  tests  as  shown  in  the  tables  are  not  the  same  for  all  the  men.  The 
order  of  the  January  and  Jnne  tests  for  the  different  men  is  given  below.  The 
tests  which  were  taken  in  March  are  in  italics. 


B 

/ 

2 

3 

4 

o 

E 

1 

2 

3 

4 

0 

Lq 

1 

J 

4 

3 

5 

Lw 

1 

2 

3 

4 

5 

M 

1 

5 

2 

3 

4 

P 

3 

1 

5 

2 

4 

R 

1 

3 

4 

5 

T 

1 

o 

3 

4 

5 

W 

3 

J 

1 

2 

4 

20  Fisher — The  Effect  of  Diet  on  Endurance. 

TABLE  XI. 
TESTS   OF  PHYSICAL  ENDURANCE. 

B        E         Lq       Lw      M         P         R  T  W 

(   Rising   Jan.   300  1007   333 '  69'  127  1483   702  900  1263 

(1)-    on    Mar.  400'^  1265^  2620^  65 1  400'  ....  .  831  ^  1500-*  .... 

\       Toes   June  500-  1061'  3000 ^  85 ^  1500 ^  1800^  1263 ^  1800 ^  3350  ^ 

(   Deep   Jan.   82   142    70   48   132   208   374  129  404 
(2)-   Knee   Mar.   ...   ...   191'  47"  ... 

(  Bending  June  200^   81''  202^  58'  155^  2302  453'  250^  508* 

(        T-              Jan.        25«       526        93     22«       30"     27e         50^  23"  30« 

(3)^'     T,  .?         Mar.      ._.       ._.       ...       33"     ...       34«       ...  ...  40^ 

(     raising      j^^^^g       335       3g6      206     356       316     376       103"  19'^  53 

(      5-lb.        Jan.        75 «     138 «      78«    38«      51 «    44''       100  ^  83  6  i85« 
(4)  ■^' Dumb-bell  Mar.      ...       ...       1066  ...       ...     ... 

(    (triceps)     June     1276       59 «       806     51 6       756     56  6       io46  1016  501  e 

MS       MS       M     S      M     S        MS       MS        MS  MS  MS 

f    Holding    Jan.    5-  0     1-33     4-  7     3-37     3-30     5-39     2-  5  3-22  11-  0 

(~'i)\       Arms       Mar 5-49     15-35 

[^Horizontal  June  9-36  6  2-56'  3-50'  3-0'  6-0     10-1  =  3-16'  3-24'  23-45' 

,« J  Ti  ~'YY  ,,   Jan.        506       186       166       66      20  6     116        10 «  256  545 

f    (bice  3s)     ^"'^*^     1056      106      oge    336      30  6    29 «        27  ^  75  ^  108  ^ 


6  ' 


Criticism  of  JRecoi'ds  of  Physical  Endurance. 

That  the  fatigue  after  the  March  and  June  tests  was  in  general 
much  less  than  after  the  January  test  was  made  evident  by  three 
substantial  proofs.  The  first  was  the  feelings  of  the  men  themselves 
as  recorded  in  the  foot-notes  to  Table  XL  After  the  March  and  J  une 
tests,  every  man  of  the  eight  who  showed  improvement  felt  "  not 
tired,"  or  "  less  tired  than  in  January  test,"  which  is  the  same  as 
saying  -'not  exhausted";  or  else  he  had  gone  "  to  limit"  as  in  Jan- 
uary, which  means  that  the  muscle  itself  refused  to  continue  work. 
The  last  was  usually  true  of  the  "leg-raising,"  "raising  o-lb.  dumb- 
bell (triceps)"  and  "raising  25-lb.  dumb-bell  (biceps)".  The  only  tests 
in  which  thei-e  was  the  possibility  of  being  mistaken  as  to  the  degree 
of  fatigue  were  the  "rising  on  toes"  and  "holding  arms  horizontal." 
In  the  former  fatigue  comes  so  slowly,  and  in  the  latter  the  pain  is 
so  intense  that  they  prove  to  be  tests  of  will  power  or  "grit  "  quite  as 

^  Cramped. 

^  Not  as  tired  as  in  January  test. 

^  Not  to  limit. 

*  Not  nearly  as  tired  as  in  January  test. 

5  Not  tired. 

6  To  limit  of  muscle's  eapacity. 

'  About  same  fatigue  as  in  January, 


Fisher — T/ie  Ffeet  of  Diet  on  Endurance.  21 

much  as  of  muscle  power.  lu  tliese  cases  the  men  had  some  difficulty 
in  remembering-  the  original  degree  of  fatigue.  But  tiie  increases 
were  so  great  and  the  men  were  so  positive  as  to  their  feelings  that 
there  remains  little  room  to  doubt  the  substantial  correctness  of  the 
results.  In  a  few  other  individual  cases,  as  of  Lw.  and  L<j.,  whose 
records  in  test  1  were  sometimes  stopped  by  cramps,  there  is  some 
room  for  doubt  as  to  the  correctness  of  the  recorded  improvement. 

The  second  proof  that  the  fatigue  of  the  men  in  the  June  tests  was 
less  than  that  in  the  January  tests  was  found  in  the  fact  that  the 
stiffness  and  soreness  which  followed  in  June  were  markedly  less 
than  in  January  and  of  much  shorter  duration.  This  Avas  true  of  all 
the  eight  men  who  showed  improvement,  except  R. 

The  third  proof  of  less  fatigue  in  June  than  in  January  for  the 
eight  men  is  that  in  June  the  men  finished  the  ordeal  of  the  endurance 
tests  with  more  strength  left  than  in  January,  although,  as  we  saw 
from  Table  X,  they  began  the  two  tests  with  slightly  less  strength. 
The  fact  that  they  had  more  strength  left  after  the  June  test  is  made 
evident  by  the  first  part  of  test  6,  given  below,  which  in  each  case 
came  after  the  endurance  tests  were  nearly  or  quite  finished.  This 
consisted  in  lifting  a  50-lb.  dumb-bell.  The  weight  being  so  great, 
this  was  practically  a  test  of  strength  rather  than  of  endurance. 
Now  all  of  the  eight  men  who  showed  improvement  in  the  endurance 
tests  of  Table  XI,  showed  improvement  in  this  strength  test  also,  as 
the  following  table  shows: 

I 

TABLE  XII. 
LIFTING  O'v  biceps)  50-lb.  DUMB-BELL.  ^ 


B 

E 

Lq 

Lw 

M 

P 

R 

T 

W 

Jan. 

03 

13 

13 

03 

13 

03 

43 

23 

133 

June 

13 

03 

53 

83 

133 

13 

103 

12  2 

26  3 

But,  as  we  have  seen  in  Table  X,  the  strength  tests  taken  before 
the  endurance  tests  showed  a  slight  falling  off  in  June  as  compared 
with  .Januaiy  for  all  but  one  (Lq.)  of  these  eight  men.  In  other  words, 
m  June  the  men  began  their  endurance  tests  weaker  than  in  Jan- 
uaiy, but  finished  them  stronger.     The  larger  residuum  of  strength 

^  This  part  of  test  6,  being  one  of  strength  rather  than  of  endurance,  was  not 
inchided  in  the  endurance  Table  XI.  Had  it  been  included  it  would  have 
increased  even  more  the  percentage  of  improvement  shown,  for  it  shows  an 
average  increase  from  2.4  to  8.4,  or  250$«. 

2  Not  to  limit. 

3  To  limit  of  muscle's  capacity. 


22  Fisher — The  Effect  of  Diet  on  Endurance. 

left  after  the  June  tests  as  compared  with  the  January  tests  indicates 
that  the  June  tests,  in  spite  of  being  far  more  severe,  fatigued  the 
men  less. 

The  50-lb.  dumb-bell  test  resolved  the  last  doubts  in  ray  own  mind 
whether,  for  some  of  the  men,  the  recorded  results  might  not  exag- 
gerate the  true  improvement.  The  two  men  of  whose  records  I 
should  have  felt  a  little  doubt  were  B.  and  R.  Both  of  them  came 
to  the  June  test  after  prolonged  mental  exertion,  and  their  exhaustion 
at  the  end  was  far  more  evident  than  that  of  any  of  the  others.  That  it 
was  great  is  clear  from  their  own  statements  given  below,  though 
only  R.  reported  himself  as  having  been  about  as  stiff  and  sore  after 
the  June  as  after  the  January  tests.  But  both  B.  and  R.,  whereas 
they  had  less  strength  (Table  X)  before  the  June  endurance  tests 
than  before  the  January  tests,  had  more  strength  left  (Table  XII) 
after  the  June  tests  than  after  the  January  tests.  At  the  close  of 
the  January  tests  they  were  so  exhausted  that  B.  could  not  raise 
the  50-lb.  dumb-bell  at  all  and  R.  could  raise  it  onl3-  4  times.  Had 
their  exhaustion  after  the  June  tests  been  as  great,  it  seems  certain 
that  B.  would  still  have  been  unable  to  raise  it,  and  R.  would  have 
been  unable  to  raise  it  more  than  4  times  ;  but  as  it  was,  B.  raised 
it  once  and  R.  10  times. 

The  value  of  such  a  positive  proof  that  the  June  tests  were  more 
easily  endured  than  those  of  January  was  not  perceived  until  the 
figures  were  analyzed.  Had  it  occurred  to  me  in  time,  all  the  strength 
tests  1»aken  before  the  endurance  tests  would  have  been  repeated  after 
them.  It  is  true  that  the  strength  tests  at  the  beginning  were  not 
of  the  same  muscles  as  those  (the  biceps)  used  in  the  strength  test  by 
dumb-bells  at  the  end,  but,  as  Table  X  shoAvs,  the  strengths  of  different 
muscles  for  the  most  part  vary  in  unison  with  each  other.' 

It  is  significant  that  the  only  man  whose  strength,  as  shown  by  the 
above  table,  was  less  at  the  close  of  the  June  experiment  than  at  the 
close  of  the  January  experiment  was  E.,  who  was  also  the  onl}^  man 
whose  endurance  showed  any  reduction.  The  facts,  therefore,  in  his 
case  are  not  discordant  with  those  already  stated  ;  for,  as  has  been 
stated,  E.was  the  least  assiduous  in  following  the  experiment.   This  was 

'Out  of  the  108  comparisons  of  strength  (i.  e.,  comparisons  for  each  of  nine 
men  in  each  of  four  tests  for  Januax\y  vs.  March,  March  vs.  June,  and  January 
vs.  June),  only  20  are  discordant  with  the  general  trend  as  shown  by  the  totals. 
Thus,  for  B.  the  general  trend  between  March  and  June  as  shown  by  the  total 
was  downward,  and  this  downward  trend  is  found  in  all  but  one  of  his  four  tests 
the  discordant  case  being  the  "back  lift." 


.Fisher — lite  Ejf'eet  of  Diet  on  Endurance.  23 

often  ivmarked,  both  to  liiiii  and  to  me,  by  the  other  members  of  the 
elub,  and  it  was  suogested  more  than  once  that  I  should  "nudge" 
Iiiin,  But,  as  I  had  been  desiring  a  "control,"  or  a  subject  in  which 
all  the  conditions  except  mastication  were  the  same  as  for  the  other 
men,  I  decided  to  sav  nothing.  The  result  was  instructive,  for  E.'s 
ease  stood  out  as  exceptional  in  almost  all  respects.  Ilis  reduction 
in  (piantity  of  food  (Table  III),  except  for  a  sjjurt  at  the  end,  "was 
less  than  of  most  of  the  men  ;  his  reduction  in  proteid  (Table  IV), 
with  the  same  exception,  was  the  least  of  all ;  his  reduction  in 
(|Uantity  of  tlesh  foods  (Table  Y)  was  the  least  of  all  ;  his  nitrogen  in 
•lune  (Tal)le  VI)  was  one  of  the  highest  ;  his  reduction  in  volume  of 
urine  (Table  VII)  was  one  of  the  lowest  two  ;  his  improvement 
in  the  fecal  tests  (Table  VIII)  was  third  to  lowest  ;  his  loss  of 
strength  (Table  X)  was  second  greatest  ;  and  as  to  endurance,  he 
was  the  only  one  who  failed  to  show^  improvement. 

There  was  only  one  other  man,  M.,  who  was  thought,  though  in  a 
smaller  degree,  to  masticate  less  carefulh'^  than  the  experiment  called 
for  ;  and  for  him  we  find  corresponding  peculiarities,  though  in  a 
smaller  degree.  Thus,  his  reduction  in  total  daily  food  (Talkie  III) 
Avas  less  than  of  most  of  the  men  ;  his  reduction  in  proteid  (Table 
TV)  was  less  than  the  average  reduction  ;  his  reduction  in  flesh 
foods  (Table  V)  was  the  third  smallest  ;  his  June  nitrogen  was  the 
highest  (Table  VI)  ;  his  reduction  in  quantity  of  urine  (Table  VIl) 
was  one  of  the  lowest  two  ;  his  improvement  in  fecal  test  (Table  VIII) 
was  second  to  lowest  ;  his  loss  of  strength  (Table  X)  was  the  third 
greatest  (or  fourth,  if  measured  in  percentage)  ;  and  his  increase  in 
endurance,  though  great,  was  (except  in  test  1,  which  is  subject  to 
some  doubt)  less  than  the  average. 

The  shortcomings  of  these  two  men,  E.  and  M.,  as  to  mastication 
were  not  intentional,  but  due  to  carelessness  and  force  of  habit,  as 
well  as,  in  the  case  of  M.,  to  the  fact  that  he  waited  on  table  and  felt 
naturally  more  pressed  for  time.  Their  experience  is  valuable  in 
showinflf  that,  in  a  general  wav,  the  changes  in  diet  and  endurance 
Avere  proportionate  to  the  thoroughness  of  mastication  and  the  follow- 
ing of  natural  a})petite. 

The  men  kept  diaries  in  which  are  recorded  their  sufferings  after 
the  various  tests.  These  show  a  decided  lessening  in  stiffness  and  sore- 
ness in  the  later  tests,  though  in  the  June  tests  the  men  had  generally 
done  double  the  amount  of  Avork  that  thev  had  done  in  January.  It 
Avould  have  been  a  physical  impossibility  to  do  as  much  in  January 
as  Avas  easily  apcomplished  in  .Tune  in  tests  3,  4  and  G  ;  and  granted 


24  Fisher — The  Effect  of  Diet  on  Endurance. 

that  it  had  been  even  possible  in  January  to  goad  the  men  to  do  as 
much  in  tests  1,  2  and  5  as  they  did  without  urging  in  June,  they 
must  certainly  have  been  ill. 

The  following  are  statements  from  the  men  themselves  : 

Personal  Tmp7'essions  at  end  of  Experiment. 

(B)  I  was  very  sore  [after  the  June  test,  Saturday,  June  16,  1906] ' 
However,  1  think  the  soreness  was  not  so  severe  or  lasting  as  it  was 
after  the  January  test.  The  muscles  of  my  right  arm  were  swollen 
considerably  and  I  was  unable  to  straighten  it  for  two  or  three 
days.  But  the  swelling  was  not  so  severe  as  it  was  after  the 
earlier  test  and  the  arm  Avas  much  more  usable.  The  muscles  of  the 
thighs  were  the  sorest  ;  they  were  nearly  worn  out.  Daring  Sunday, 
Monday  and  Tuesday  after  the  test  I  had  difficulty  in  walking  ;  and 
going  down  stairs  was  quite  a  difficult  and  severe  undertaking. 
Wednesday  morning  the  soreness  had  not  left,  though  it  had  de- 
creased considerably.  I  took  a  considerable  tramp  that  day,  and  by 
night  I  could  scarcely  feel  the  soreness  at  all.  By  Thursday  I  had 
practically  regained  my  normal  endurance ;  walked  six  or  seven 
miles  that  day.  The  calf-muscles  too  were  quite  sore,  but  much  less 
so  than  after  the  January  test.  Thei'e  was  another  particular  dis- 
tinction. After  the  earlier  test  the  calf-muscles  were  hard  and 
knotted  for  several  days  ;  but  this  time,  while  they  wei"e  sore,  they 
were  almost  normally  soft.  Saturday  evening  when  I  Avent  to  bed 
they  were  quite  hard,  but  Sundaj^  morning  they  were  normal  and 
practically  remained  so.     .     .     . 

I  have  no  doubt  that  in  my  case  there  was  great  increase  in 
endurance,  though  I  think  that  I  lost  in  amount  of  energy  that  I 
could  exert  at  any  given  moment.  This  loss  is  due  perhaps  to  two 
things  ;  (1)  I  took,  on  the  whole,  less  exercise  than  during  the  time 
preceding  the  January  test  ;  (2)  I  had  been  working  quite  hard  for 
three  months  steadih',  while  the  January  test  followed  a  three  weeks' 
vacation  during  which  I  did  little  or  nothing.  As  to  increase  of 
endurance  there  can  be  no  doubt.  For  example,  in  the  deep  knee- 
bending,  I  began  to  get  tired  at  50  and  had  no  idea  of  going  above 
100.  When  I  reached  this  I  set  my  goal  at  125,  then  150,  160,  and 
was  able  to  reach  200  before  I  was  exhausted.  In  January,  after  I 
was  tired  I  was  not  able  to  go  on  very,  long  before  I  became  com- 
pletely exhausted.  This  shows  increased  endurance.  I  had  the 
same  experience  in  the  other  hard  physical  tests.  In  case  of  the  run, 
I  was  sure  I  could  not  go  more  than  three  laps  after  my  first  lap  ; 


Fisher — 21ie  EjfWt  of  Diet  on  Endurance.  lb 

but  I  made  1 1  <>r  1 1'  mid  could  have  Sfone  several  more.  Coiisideriiisr 
evervthino",  1  liave  no  doul)t  iliat  I  was  :il>U'  to  liaim-  on  inucli  lontrer, 
after  I  began  to  get  tired,  tlian  in  January. 

I  am  at  a  loss  to  ascribe  the  increased  endurance  to  an^-thing  else 
than  to  the  diet.  My  way  of  living  otherwise  continued  about  the 
same  after  the  Januar}^  test  as  it  was  before.  .  .  .  Personally  I 
am  convinced  that  the  increased  endurance  mnst  be  due  to  diet  and 
manner  of  eating  ;  all  other  factors  that  I  can  think  of  are  unfavor- 
able rather  than  favorable  to  more  endurance.  I  am  convinced  to 
the  extent  that  I  shall  certainly  continue  "  FletcheriziuG: "  and  usinof 
a  low-proteid  diet. 

(E)  All  effects  of  [June]  test  disappeared  entii-ely  within  four 
days.     [Effects  of  Januar}^  test  lasted  six  days.] 

(Lq)  The  stiffness  and  soreness  had  entireh^  disappeared  in  four 
days.  It  was  not  nearh'  so  severe  as  the  test  in  January.  After  I 
was  through  in  Januar}'  I  could  hardly  go  down  the  stairs  of  the 
Gymnasium,  and  three  days  after  the  test  going  up  and  down  stairs 
was  accompanied  with  a  great  deal  of  pain,  ...  I  was  stupid 
mentally  for  a  Avliole  week  the  first  time,  but  in  the  last  test  I  passed 
that  stage  in  a  couple  of  days.  .  .  .  Had  it  not  been  for  the  late 
hours  and  long  stretches  of  work,  I  should  have  been  able  to  make  a 
better  comparison  with  conditions  in  January,  though  as  it  was 
results  show  improvement. 

I  cannot  say  as  to  the  help  mentally  I  have  derived,  for  I  have, 
always  gone  to  my  limit  and  I  would  be  unwilling  to  make  any  posi- 
tive statement.  As  for  the  i>hysi«al,  I  know  there  is  an  improve- 
ment there,  for  my  stomach,  which  was  never  so  very  strong,  has 
been  greatly  helped. 

(Lw)  There  was  no  stiffness  or  soreness  felt  in  the  triceps  or  the 
stomach  muscles  as  the  result  of  the  last  tests.  The  thig^h  muscles 
were  a  little  stiff  on  the  second  day  only — about  such  stiffness  as  one 
might  expect  from  a  long  Avalk.  The  calves  of  my  legs  began  to 
stiffen  on  Friday  [June  15, 1906,  the  day  after  the  test]  and  continued 
to  do  so  on  Saturday,  after  which  the  stiffening  began  to  lessen,  and  was 
scarcely  felt  on  ^Monday.  The  biceps  of  my  right  arm  gave  me  the 
most  trouble.  These  were  sore  on  Friday  A.  M.  and  continued  to 
increase  in  soreness  till  Sunday  evening,  feeling  worst,  however, 
Sunday  A.  ]M.  When  I  arose  Monday  A.  Vi.  all  the  soreness  and 
stiffness  had  disappeared.  A  peculiarity  about  the  latter  Avhicli  im- 
pressed me  was  the  fact  that  although  my  arm  was  very  sore  it  did 
not  seem  to  be  very  stiff.     After  the  tests  in  January  I  could  not 


26  Fisher — The  Effect  of  Diet  on  Eadaranoe. 

straighten  my  arm,  but  I  could  after  the  last  tests  in  spite  of  the 
extreme  soreness.  I  had  entirely  recovered  by  Monday  from  the 
tests.  At  no  time  after  the  tests  did  I  feel  any  pain  in  proceeding 
up  and  down  stairs,  and  if  I  remember  rightly  I  couldn't  say  the  same 
in  January;  neither  did  I  feel  particularly  uncomfortable  at  any  time. 
After  the  half-mile  run  and  the  lifting  tests  which  I  took  later,  I  felt 
no  soreness  or  stiffness  afterward.     .     .     . 

I  think  the  credit  must  be  given  to  the  diet  experiment.  I  have 
worked  harder  from  January  to  June  than  ever  before,  and  have  taken 
less  exercise.  As  my  mental  work  was  so  different  from  that  previous, 
I  cannot  form  an  estimate  of  any  increase  or  decrease  in  efficienc}", 
but  as  I  have  said  before,  I  alwavs  rested  ud  more  quicklv.  Durinof 
the  spring  I  have  not  felt  that  "  all  gone  feeling  "  which  usually  has 
appeared  in  the  past.  The  diet  which  we  have  had  has  relieved  me 
of  the  sour  stomach  after  meals,  and  I  have  felt  better  and  worked 
harder  on  less  exercise  than  ever  before.  .  .  .  After  a  moderate 
amount  of  exercise,  I  have  felt  no  such  stiffness  as  used  to  come. 

(M)  The  stiffness  and  soreness  Avere  entirely  worn  off  in  two 
davs.  I  did  not  feel  it  nearly  as  much  as  I  did  last  .January.  In  fact, 
I  did  not  exert  myself  to  the  utmost  this  last  time  because  I  had  sev- 
eral examinations  to  take  a  day  or  two  later. 

My  general  impression  is  that  the  experiment  was  an  all  around 
benefit  to  me.  I  fully  believe  that  during  the  tests,  thej'  reflected 
the  true  state  of  the  case  in  showing  my  efficiency  in  June  compared 
with  that  in  January.  I  believe  that  there  was  a  decided  improve- 
ment in  efficienc}'^  and  could  ascribe  it  partly  to  my  exercise  and  the 
other  part  to  the  new  manner  of  eating.  I  believe,  however,  that  my 
exercise  played  a  \evj  small  part  because  I  think  what  I  gained  in 
exercise  I  lost  in  sickness  [mumps]. 

My  exercise  this  year  was  practically  the  same  as  years  preceding. 
After  April  1st  I  had  very  little  exercise,  on  account  of  the  mumps. 
This  left  me  in  a  weak  condition  over  a  month.  I  had  lots  of  work 
to  make  up  and  studied  harder  from  April  to  June  than  3L\\y  other 
period  of  my  course.  M}^  exercise  was  neglected  these  three  months 
and  I  studied  almost  constantly  every  day  and  until  12  at  night. 

My  experience  has  shown  me  that  I  was  at  my  best  in  mind  and 
body  when  I  ate  meat  four  times  a  week.  I  have  tried  both  more  and 
less  and  found  the  above  to  be  the  medium.  I  also  found  that  I  could 
do  more  when  I  had  the  largest  meal  at  noon.  The  greatest  benefit 
of  the  experiment  to  me  personally  is  that  last  year  I  broke  down  in 
the  spring  term  and  this  spring  I  kept  up  my  work  and  health  in  a 
much  better  condition. 


Fisher —  Th(   J'Jft'ect  of  Diet  ott  Eiidur<mce.  27 

(P)  T  wi'nt  into  tlie  second  tost  witli  some  trepidation,  knowing 
tliat  1  had  lost  eoiisi(leral)le  weight  the  preceding  ten  weeks. 
Physically,  I  cannot  say  that  I  felt  stronger  before  the  second  test 
than  before  the  first  ;  nor  did  I  feel  weaker.  As  tlie  test  developed, 
however,  I  soon  saw  that  njy  endnrance,  both  mental  and  ]thysical, 
had  increased. 

Generally  speaking,  the  soreness  was  less  extensive,  less  trying  or 
acute,  and  (I  think)  shorter-lived  than  in  January.  ...  It  seems 
to  me,  as  1  tinishe<l  the  test  much  fresher  than  in  January,  a  clear 
gain  in  efficiency  is  proven.  The  test  seemed  certainly  to  make  a 
true  re})ort. 

I  can  ascribe  sain  in  endurance  to  nothinf'"  l)ut  the  diet  and  thor- 
ough  mastication.  Every  other  factor  in  the  situation  was  against 
this  gain — exercise,  of  which  I  took  certainly  no  more  than  usual 
and  in  the  latter  weeks  much  less  ;  work,  of  which  I  had  had  a  long, 
hard  pull  as  against  the  three  weeks'  rest  preceding  the  Januarj'" 
test  ;  sleep,  iiuich  decreased  for  most  of  May  and  June.  You  stated 
last  December  that  you  wished  every  factor  to  be  in  favor  of  the 
first  test  and  against  the  second.  This  condition  has  been  true  in 
high  degree  for  my  case.  .  .  Whatever  the  efficacy  of  the  two 
tests  in  proving  the  superiority  of  low  proteid  and  thorough  masti- 
cation for  the  other  members  of  the  club,  I  feel  convinced  that  they 
prove  that  superioritj'  with  considerable  force  in  my  own  case. 

I  have  tried  meat  and  chicken  a  number  of  times  in  the  last  two 
weeks,  partly  from  curiosity  and  partly  from  necessity.  But  in  every 
case  anticipation  has  been  pleasanter  than  realization,  and  my  low- 
jiroteid  tendencies  bid  fair  to  remain  for  some  time  to  come.  I  may 
say  that  I  had  no  opinion  on  the  diet  question  when  the  experiment 
started,  but  am  now  a  hearty  low-proteid  exponent. 

I  went  into  the  test  with  considerable  foreboding  as  to  my  endur- 
ance showing  ;  for  I  have  worked  now  without  a  break  for  twenty- 
two  weeks  at  hard  mental  labor,  the  last  two  weeks  being  especialh'' 
confining  and  involving  large  losses  of  sleep  and  exercise.  I  may 
say  that  I  have  been  unusually  well  for  six  or  eight  weeks,  and 
bowels  have  been  running  with  greater  ease  and  constancy  than  for 
several  years,  .  .  The  endurance-tests,  showini;  a  arood  inci'ease 
in  every  test,  consequently  came  as  a  complete  surprise  ;  and  my 
self-confidence,  largely  absent  at  the  start,  returned  in  increasing 
measure  as  the  test  went  on.     .     . 

Thursday,  June  21  [5  days  after  test].  Played  golf  this  morning 
and  afternoon   (9  holes  each  time)   with   perfect   ease,  no  difficulty 


28  Fisher — The  Effect  of  Diet  on  Endurance. 

Avith  walking  or  driving  the  ball.     Soreness  wholly  gone  at  present 
writing,  no  touch  of  it  noticeable  anywhere. 

.  (R)  The  outcome  of  the  last  endurance  test  was  about  the  same 
as  the  one  held  January  14,  1906.  I  was  fearfully  sore  for  about  one 
week,  reaching  the  climax  at  the  middle  of  the  week. 

(T)  Throughout  the  test  I  passed  from  one  event  to  another 
with  much  shorter  periods  between  than  I  did  in  January.  With  the 
exception  of  l^'ing  on  my  back  and  raising  ray  feet,  I  at  no  time  ap- 
proached as  near  exhaustion  as  I  did  in  January.  In  January,  in  rising 
on  my  toes  and  in  the  deep  knee-bending,  I  continued  till  I  fell  to 
the  floor.  I  was  not  exhausted  at  the  close  [of  the  June  test],  but 
marked  papers  for  2-|  hours  before  going  to  bed.  Sunday  I  scarcely 
felt  any  the  worse,  though  my  muscles  felt  a  little  queer  when  I  poked 
my  finger  into  them.  Monday  my  leg  muscles  were  a  little  stiff 
after  a  period  of  rest,  but  not  painful  in  the  least.  My  right  shoulder 
was  a  trifle  lame,  due  wholly  I  think  to  hitting  it  once  in  a  while  in 
the  last  test  with  the  10  and  5-lb.  Aveights.  My  right  arm  at  the 
elbow  was  decidedly  lame  and  would  not  admit  of  being  completely 
straightened,  though  it  was  undoubtedly  better  than  in  January. 
By  Tuesday  all  the  other  stiffness  had  practically  left  me  except  the 
right  elbow,  which  was,  however,  better.  By  Thursday  I  was  unable 
to  detect  any  soreness  whatever  in  any  part. 

(W)  May  31.  After  the  test  I  felt  fairly  tired  and  ready  to  quit 
— however,  not  nearly  so  exhausted  as  before  in  January.  Could 
walk  down  stairs  with  more  confidence  and  could  raise  my  supper  to 
my  mouth  much  more  easily  than  after  the  first  test.  .  .  .  The 
results  certainly  far  surpassed  any  expectation  I  had,  especially  as 
in  the  morning  I  did  not  feel  quite  as  spry  and  active  as  usual,  due 
to  a  little  unusual  over-exertion  the  previous  day. 

June  1.     Sore  in  thighs  and  biceps,  also  felt  my  abdominal  muscles. 

June  2.  Expected  to  be  much  worse  on  this  the  second  day,  as  in 
January,  but  not  so.  About  same  as  yesterday.  Later  in  the  day 
could  run  up-stairs  two  steps  at  a  time  as  I  could  yesterday— a  thing 
undreamed  of  in  January  for  .over  a  week  after  the  test. 

June  3.  Felt  pretty  well  today,  much  improved  over  yesterday, 
still  felt  my  thighs  in  walking  down  hill  or  down  stairs,  but  not 
nearly  as  bad  as  yesterday. 

June  4.  Feel  my  thighs  only  very  little,  other  muscles  not  felt  at 
all.     Rode  a  bicycle  5^  miles  ;  did  not  feel  it. 

June  5.     Seem  to  be  all  well,  haven't  noticed  a  soreness  all  day. 


Fisher — The  Efect  of  Diet  on  Endurance.  29 

The   followiiic:  table  oxprosses  tlic   ]i(i-cciitago  of  iiii]ir(n('incnt  in 
tlic  records  ot"  Table  XI. 

TABLE    XIII. 
IMPROVEMENT  IX  PHYSICAL  ENDURANCE  IN  PERCENTAGES. 


B 

E 

Lq 

Lw 

M 

P 

R 

T 

W 

...    (Jan. 
^^'    (Jan. 

-Mar. 
-Jiine 

33  + 

66  + 

26  ± 

5± 

686- 

800- 

-5± 
23  ± 

215  ± 

1081  ± 

li  + 

18  + 

79  + 

66  + 

100  + 

16.5  + 

^~>    i  Jan. 

-Mar. 
-June 

144  + 

-43  ± 

172  ± 
188  + 

-2± 

21  ± 

"17  + 

'10  + 

'21  ± 

'94  + 

'26  + 

,.^     \  Jau. 
(•^'    "<Jau. 

-Mar. 
-June 

'■62 

-ir 

122- 

59 

"3 

26 
37 

106 

-17 

33 

77 

^^'    (Jan. 

-Mar. 
-June 

"69 

-57 

36 
2 

'34 

'47 

'27 

"4 

'22 

170 

-  '    (Jan. 

-Mar. 
-June 

"9C'- 

'8S>± 

-7± 

-17  ± 

66  ± 

74  ± 

"77  + 

"56± 

""i± 

42  ± 
115± 

(6)  ■{  Jan. 

-June 

110 

-44 

62 

450 

50 

163 

170 

200 

100  + 

^'  •    /  Jan. 

-Mar. 
-June 

38  + 

85  ± 

26  ± 

-13± 

208  ± 
194± 

14± 
95  + 

140  ± 

212  ± 

26 
56  + 

18  + 
73  ± 

66  + 
66  ± 

37  ± 
109  ± 

In  the  preceding  table  most  of  tlie  figures  are  succeeded  by  a  "4-", 
which  signifies  that  the  true  improvement  was  greater  than  the 
figures  indicate.  Thus,  the  first  entry  in  Table  XIII,  "  33  +  ",  means 
that  B.'s  improvement  between  January  and  March  in  test  (1) 
(rising  on  toes)  was  9nore  than  33^,  Similarly,  "686-"  for  Lq.  in 
same  test  means  that  improvement  was  less  than  686^5^.  Again, 
"•215+ "for  M.'s  same  test  signifies  that  his  improvement  in  this 
test  may  have  been  greater  or  less  than  215^.  Finally,  when  any 
figure  is  not  followed  by  a  sign,  as  for  instance,  B.'s  (3)  (leg  raising), 
the  meaning  is  that  the  figure  given  is,  humanly  speaking,  correct. 
This  accuracy  applies  onl}^  to  those  tests  in  which  the  muscles  were 
worked  till  they  were  physicalh'  unable  to  repeat  the  movement. 
The  reasons  for  the  various  suffixes  may  be  found  by  studying  the 
foot-notes  of  Table  XI.' 

^  For  instance  the  "  +  "  after  33  for  B.'s  (1)  is  explained  by  the  fact  (as  indi- 
cated in  the  foot-note  to  Table  XI)  that  after  his  March  test  he  was  not  as  fatigued 
as  after  his  January  test,  although  he  had  improved  upon  his  January  record 
by  33^.  The  only  cases  in  which  the  explanation  of  the  suffi.xes  will  not  be 
foiind  from  the  foot-notes  to  Table  XI  are  the  following:  E.'s  (1),  26 ±,  in 
which  case  the  "— "  is  inserted  owing  to  the  fact  that  E.  had  come  to  the  March 
test  after  the  refreshment  of  a  nap  ;  and  M.'s  (1),  1081  ±,  in  which  case  the  "  — " 
is  inserted  owing  to  the  fact  that  this  high  figure  is  inconsistent  with  the  other 
resiilts  of  the  test,  it  being  thought  that  M.  may  have  been  mistaken  in  his 


30  Fisher — The  Effect  of  Diet  on  Endurance. 

The  table  shows  enormous  differences  in  the  figures  even  of  the 
same  man  for  the  same  period.  Thus,  the  June  improvement  of 
W.  reads  165 +  ,  26  +  ,  77,  170,  115 ±,  100 +  .  Such  wide  differences 
between  the  improvements  in  different  tests  seem  puzzling  at  first, 
but  they  are  explained,  partly  if  not  wholly,  by  two  reasons.  The 
first  is  the  obvious  one  that  many  of  the  figures  are  not  exact  records, 
but  understatements,  and  naturally  their  margin  within  the  truth 
will  vary  widely.  Thus,  the  records  for  deep  knee-bending  (2)  for 
W.  i>how  merely  that  the  improvement  is  over  26^  ;  the  true  figure 
may  well  be  100^,  which  would  be  more  consistent  with  the  other 
figures.  But  the  deep  knee-bending  test  had  been  found  in  January 
very  painful  and  inconvenient  in  its  after-effects,  and  there  was  there- 
fore less  inclination  in  the  June  tests  to  approach  closely  to  the  limit 
in  this  particular  test. 

The  other  reason  is  that  in  some  tests  a  larger  fraction  of  the  total 
strength  of  the  muscle  tested  was  called  into  play  than  in  others. 
Thus,  "leg  raising"  requires  a  very  large  fraction  of  the  strength  of 
the  abdominal  muscles,  Avhile  "rising  on  toes"  requires  only  a  small 
fraction  of  the  strength  of  the  calf  muscles.  This  may  explain  why, 
in  general,  the  improvement  in  the  test  of  the  calf  muscles  seemed 
so  much  greater  than  in  that  of  the  abdominal  muscles.  This  expla- 
nation is,  however,  purely  hypothetical.  It  would  be  interesting  to 
find  out  experimentally  how  much  an  improvement  in  the  endurance 
of  a  muscle  shows  itself  when  it  is  exerted  in  different  degrees,  say  to 
75^,  50^  and  25^  of  its  strength-capacity.' 

Bearing  in  mind  these  two  possible  reasons  for  the  variations  in  the 
figures,  and  also  the  fact  that  there  must  have  been  more  or  less  actual 
differences  in  the  improvement  of  different  muscles,  we  need  not  be 
surprised  at  the  disparities  which  the  table  shows. 

If  we  omit  the  cases  in  which  the  records  are  at  all  doubtful  (with 
sufiix  ±)  or  exaggerated  (suftix  — -),  we  have  left  the  following  table 
for  the  eight  men  who  showed  improvement  : 

remembrance  of  his  January  test.  The  "  — "  has  been  inserted  whenever  there 
was  the  slightest  ground  of  any  kind  for  thinking  the  figures  might  be  overstate- 
ments. With  these  figures  weeded  out,  the  remaining  ones  certainly  understate 
the  actual  improvement. 

'  The  original  object  of  using  the  graded  dumb-bells,  50-lb.,  35-lb.,  10-lb., 
and  5-lb. ,  for  testing  the  biceps,  was  to  throw  light  on  this  problem  ;  but  for 
reasons  previously  stated,  these  tests  were  not  fully  carried  out. 


Msher — 'J^he  Efect  of  Diet  o)i  Eiiduranve.  31 

TABLli  XIV. 

PERCENTAGE  OK  IMPROVEMENT  (exact  or  uiidfistated) 
OF  ElOHT  MEN. 


B 

Lci 

Lw 

M 

P 

R 

T 

W 

a) 

Jan. -Mar. 

Jan. -June 

33  + 

6(i  + 

... 

... 

::: 

'21  + 

18  + 
7i»  + 

66  + 

100  + 

16.5 

(2) 

(  Jan. -Mar. 
\  Jan. -June 

144  + 

188  + 

... 

"17  + 

'io  + 

::: 

"94  + 

'26 

(a) 

i  Jan. -Mar. 
i  J  an, -June 

":« 

... 

.10 
5!» 

0 

26 
37 

106 

-17 

33 

1    1 

(4) 

(  Jan. -Mar. 
(  Jan. -J line 

"ti9 

36 

"34 

'47 

'27 

"4 

22 

170 

(•^) 

Jan. -Mar. 
Jan. -June 

... 

... 

--- 

... 

77  + 

... 

... 

... 

(6) 

-[  Jan. -June 

110 

(52 

4.50 

.50 

163 

170 

200 

100 

Av. 

<  Jan. -Mar. 
\  Jan. -June 

:5:}  + 

84  + 

:5G 

84  + 

.50 
181 

"29  + 

26 
56  + 

18  + 
89  + 

66  + 
80  + 

33 
107 

The  figures  of  Table  XIV  show  an  undoubted  increase  in  endur- 
ance, both  for  the  first  lialf  and  more  especially  for  the  Avhole 
period  of  the  experiment. 

But,  for  an  accurate  j^resentation,  we  may  cainy  our  criticism  one 
stage  further.  The  figures  given  hitherto  represent  a  conglomerate 
sort  of  endurance,  made  up  of  endurance  of  different  muscles  su})ject 
to  different  degrees  of  strain.  As  pointed  out  before,  the  calf  mus- 
cles were  called  upon  for  onl}'  a  small  fraction  of  their  strength - 
capacity,  whereas  the  abdominal  muscles  were  called  upon  for  a  very 
large  fraction.  Moreover,  the  fraction  must  have  varied  somewhat 
in  different  tests,  according  to  the  variation  in  strength  and  weight. 
An  ideal  test  would  be  one  in  which  the  same  fraction  of  strength 
Avas  used. ' 

Fortunately,  such  an  exact  test  is  afforded  by  the  2o-lb.  dumb- 
bell. Tt  followed  immediately  after  the  50-lb.  dumb-bell  had  been 
raised  until  the  biceps  was  unable  to  repeat  the  motion.  At  the 
moment  the  .50-lb.  test  ended,  the  25-lb.  test  began.  At  this  moment 
the  strength  of  the  biceps  was  just  at  or  barely  below  the  fifty  lbs. 
required  to  raise  the  heavier  dumb-bell.  In  other  words,  in  raising  the 
25-lb.  dumb-bell  the  muscle  needed  just  fifty  j^^r  cent,  of  its  strength 
at  the  time  the  test  began.  The  use  of  the  25-lb.  dumb-bell  grad- 
ualh'  reduced  this  strength  from  50  to  25  lbs.     The  test  was  there- 

^  It  is  on  this  principle  that  the  new  ergograph,  before  referred  to,  is  con- 
structed. 


32  Fishei — The  Effect  of  Diet  on  Endurance. 

fore  perfectly  uniform  for  all  the  men  ;  it  showed  how  many  con- 
tractions were  necessary  in  each  case  to  bring  down  the  strength  of 
the  biceps  from  50  to  25  ;  it  showed  how  much  the  muscle  could 
endure  before  being  robbed,  by  fatigue,  of  half  its  strength.  Thus  at 
the  beginning  the  strength  is  50  lbs. ;  after  the  first  contraction  it  is, 
say,  49  ;  after  the  second,  48,  etc.  But  the  contractions  continue  until 
the  strength  sinks  below  25  lbs.  The  loss  of  strength  maybe  said  to 
measure  fatigue.  The  sloioness  of  this  loss  may  be  said  to  measure 
endurance  and  is  well  indicated  by  the  number  of  contractions 
necessary  to  tire  a  muscle  from  a  strength  of  50  lbs.  to  a  strength  of 
25  lbs. 

Four  exceptions,  however,  need  to  be  noted.  Three  men,  B.,  Lw. 
and  P.,  were  unable  in  January  to  raise  the  50-lb.  dumb-bell  at  all 
(see  Table  XII).  Consequently  their  January  test  with  the  25-lb. 
dumb-bell  did  not  begin  at  50^  of  the  strength,  but  at  a  higher  frac- 
tion. This  explains  their  high  apparent  improvement.  Thus,  Lw.  is 
credited  with  an  improvement  of  450^*,  because  in  January  he  could 
raise  the  25-lb.  dumb-bell  only  6  times,  and  in  June,  33  times. 
But  the  33  contractions  in  June  began  at  just  50fo  of  the  strength  of 
the  muscle,  owing  to  its  previous  exhaustion  to  the  50-lb.  level  by 
the  50-lb.  dumb-bell,  whereas  the  six  contractions  in  January  began 
at  a  higher  level ;  for  at  that  time  the  biceps  could  not  raise  the 
50-lb.  dumb-bell  at  all.  Its  strength  was  at  that  time  less  than  50 
lbs.,  say  40  lbs.,  in  which  case  the  lifting  of  the  25-lb.  dumb-bell 
required  not  50,^  but  62-^^  of  its  strength.  To  compare  a  50^  test  of 
June  with  a  62^^  test  in  Januaiy  gives  a  record  of  improvement 
which  is  not  one  of  pure  endurance,  but  which  includes  the  element 
of  increased  strength.  This  is  "  endurance  "  in  the  crude  sense  in 
which  we  may  say  a  man  has  more  endurance  for  carrying  trunks 
than  a  boy  ;  but  for  a  comparison  of  pure  endurance,  the  boy  should 
be  given  smaller  trunks  to  handle  than  the  man. 

The  fourth  case  is  E.,  to  whom  the  reverse  reasoning  applies.  In 
June  when  he  I'eached  test  6,  he  was  unable  to  raise  the  50-lb.  dumb- 
bell at  all,  though  in  January  he  had  raised  it  once.  Hence,  while 
the  25-lb.  dumb-bell  was  a  50^  test  in  January,  it  was  a  more 
severe  one  in  June,  and  the  -44^  which  records  his  falling  off  does 
not  represent  a  pure  loss  in  endurance,  but  partly  also  a  loss  of 
strength.  To  reckon  pure  endurance  we  need  to  bring  -44  up  toward 
zero. 

Making  the  four  omissions  just  mentioned,  we  may  use  the  remain- 
ing records  from  the  last  line  of  Table  XIII,  as  a  barometer  of  pure 
endurance. 


Fisher — The  Efect  of  Diet  on  Endurance.  33 

* 

We  theroforc'  liave  tlirco  iiu'tluxls  of  estiiiKiting  tlie  increase  of 
endurance  V)et\veen  January  aiul  June.  These  may  be  put  together 
in  the  following  table  : 

TABLE  XV. 

PERCENTAGE  OF  INCREASE  OF  ENDURANCE,  JANUARY  TO  JUNE. 

BY  THREE  METHODS. 

B  E  Lq         Lw  M  P  R  T  W 

Avera-e     )        ^-         _^.^        ^,^  t,-^     2^o^        56+    70^       06  ±       109  ± 

0  tests       ) 

Omittine:     ) 

(lonbtfnl     -       84+     ---         84+     181  20+        56+     80+       80+       107  + 

cases  "  +  ''    ) 

• '  Pure  "     ) 
emliirance    -      ---         ---  62        ...  50  ...      170        200         100  + 

of  biceps    ) 

The  first  line  of  this  table  tells  us  the  average  of  the  recorded  im- 
])rovement  in  endurance  shovvai  for  each  man.  But  as  each  such  aver- 
age is  made  up  from  the  figures  of  Table  XIII,  some  of  which,  as 
indicated  in  that  table,  ai'e  possibly  too  high,  some  doubt  necessarily 
attaches  to  it,  though  practically  the  only  real  cases  of  doubt  are 
Lq.  and  M.  The  a\^erage  of  these  averages  is  101^  for  the  entire 
club,  and  is  probably  within  the  truth  ;  for  most  of  the  individual 
figures  which  go  to  make  up  this  result  are  understatements,  not 
overstatements. 

The  second  line  shows  the  average  improvement  in  tests  in  which 
there  is  no  doubt  that  the  figure  is  at  least  not  too  high,  though  it 
may  be  too  low.  The  average  of  these  is  89^,  and  is  therefore  cer- 
tainly too  low  an  estimate  of  the  average  improvement  for  the  eight 
men  who  improved  at  all. 

The  third  line  shows  the  increase  of  ^:>?^;'e  endurance  (that  is,  en- 
durance considered  apart  from  strength)  for  the  five  men  for  whom 
the  figures  were  available.     The  average  of  these  is  116^. 

We  are  quite  safe  in  saying  therefore  that  the  average  improvement 
of  the  eight  men  who  improved  was  90^.  As  to  the  degree  of  retro- 
gression of  E.,  it  is  difficult  to  say,  though  it  is  believed  that  the  fig- 
ures exaggerate  it.  This  is  certainly  true  of  the  2.5-lb,  dumb-bell  test, 
for  reasons  given.  My  own  impression,  and  E.'s  also,  is  that  he  actually 
gained  in  endurance  from  the  dietetic  experiment,  but  that  his  gain 
was  not  enough  to  offset  the  loss  occasioned  by  (1)  the  hard  term's 
work,  which,  as  in  the  case  of  the  other  men,  was  a  decided  handicap, 
and  (2)  the  omission  of  his  customary  exercises,  which  must  have 

Trans.  Conn.  Acad.,  Vol.  XIII.  3  May,  1907. 


34  Fisher — The  Effect  of  Diet  on  Endurance. 

* 

been  a  greater  handicap  in  his  case  than  in  any  other  of  tlie  men  ; 
for  he  had  been  accustomed  for  six  j'ears  to  heavy  gymnasium  train- 
ing, but  during  the  year  of  the  experiment  this  training  was  given 
up,  largely  because  of  the  difficulty  in  finding  time  for  it.  If  this 
interpretation  is  correct,  we  may  liken  the  experiment  to  nine  men  try- 
ing to  swim  against  a  current.  The  eight  who  exerted  themselves 
the  most  succeeded  in  forging  ahead ;  the  one  who  tried  the  least 
drifted  backward,  though  the  effect  of  the  swimming  (dieting)  was  to 
propel  him  forward.  Whether  or  not  E.  was  actually  propelled  for- 
Avard  by  diet  must  remain  a  matter  of  conjecture  or  inference  ;  but 
that  the  other  eight  men  gained  is  an  established  fact. 

Changes  in  Mental  Endurance. 

The  mental  test  consisted  in  adding  a  specified  number  of  figures. 
The  followinof  tables  show  the  time  durintj  Avhich  the  addition  was 
performed  and  the  number  of  errors  committed  : 

TABLE   XVI. 

TIME  OF  PEEFORMING  A  UNIFORM  AMOUNT  OF  ADDITION. 

BELqLwM         P         RTW  Average 

MSMS      MSMSMS      MS      MSMSMSMS 

Time    (    Jau.   14  5  40    4  49    6  15    4  54    6  46    3     17    6    6  41    4    6    5  29 

of       -     Mar.  28  5  16    4  27    4  35    4  15    5  47    2  43    6  32    7  18    4  34    5     3 

adding  (  '  June  16  4  50    5     9    4  40    4  23    5  50    2  58    7     3    6     5    4     7    5     0 

This  shows  that  during  the  first  period  seven  had  improved  and 
two  had  fallen  oif,  and  on  an  average  there  had  been  a  decrease  from 
5m.  29s.  to  5m.  3s.,  an  average  improvement  of  26s.  W.  showed  an 
increase  in  time  of  adding,  although  he  Avould  naturall}^  have  been 
expected  to  improve  on  account  of  having  taken  up  clerical  work 
involving  adding. 

During  the  second  period  there  was  an  average  improvement  of 
only  3s.  ;  three  retrogressed  1 5s.  to  42s.,  three  retrogressed  3s.  to  8s., 
and  three  improved  26s.  to  VSs.  The  fact  that  the  men  held  their 
own  in  the  June  adding  test  is  probably  indicative  of  actual  improve- 
ment, for  they  were  fatigued  mentally  by  examinations,  etc.,  on  the 
day  when  they  entered  the  June  test.  During  the  entire  experiment 
there  was  an  average  impi'ovement  of  29s.  ;  seven  had  improved  and 
two  had  retrogressed  (Is.  and  20s.) 

'E.,  Lw.,  R.  and  "W.  taken  on  May  31. 


Fisher —  The  Effect  of  Diet  on   Endurance.  35 

The   followiiin-  table  sliows  that  the  iiuuiher  of  errors  coiiiinitted 
was  remarkably  constant  for  most  of  the  men  and  for  the  averaije  : 

TABLE  XVII. 
NUMBER  OF  ERRORS  OF  ADDITION. 


B  E  Lq  L\v      M       P        R        T       W  Average 

10  8  1-2  4 

-V  lujir.    -;o           lb  O  8  4 

( June  16          8  13  Tt  4 


(Jan.   14         10  8         12         4         112         11         4.4 

Errors  \  Mar.  28        16  5  8        4        ;'.        0        :!         -J         1         4.6 


16        0        2        4.5 


The  adding  test  was  too  short  to  be  of  great  value.  In  future 
tests  a  larger  number  of  figures  will  be  employed,  and  a  different 
method.  After  the  specified  amount  of  adding  has  been  done,  it 
will  be  at  once  rei)eated«on  another  equivalent  set  of  examples.  The 
excess  of  time  required  for  the  second  set  over  that  required  for  the 
first  may  be  called  the  "  fatigue  time,"  and  this  fatigue  time,  taken 
as  a  percentage  of  the  total  time  of  adding,  may  be  \ised  as  a  criterion 
of  endurance — the  less  it  is,  the  greater  the  endurance,  and  vice 
versa.  This  plan  was  developed  too  late  to  be  put  into  operation  at 
the  beginning  of  the  experiment.  It  was,  however,  employed  in  the 
March  and  June  tests,  and  confirmed  the  conclusion  reached  above, 
that  there  was  little  difference  between  the  mental  endurance  in 
^larch  and  June.  Five  of  the  men  showed  a  less  "fatigue  time  "  in 
June  than  in  March,  and  four  a  greater. 

The  foUoAving  statements  of  the  men  themselves  Avill  show  that 
tlieir  feelings  as  to  working  power  were  in  harmony  with  the  conclu- 
sion that  it  had  improved  : 

Subjective  Jmjyressions  as  to  Mental  Working  Power. 

13.  (March)  "  Xot  decreased  at  any  rate,  seems  to  have  increased." 
(June)  I  did  more  work  during  the  latter  part  of  year  than  I 
ever  did  before  in  an  equal  period  of  time.  But,  I  had  the 
work  to  do  and  compelled  myself  to  do  it.  However,  I  was 
mentally  tired  at  the  close  of  the  year,  particularly  so  at  the 
time  of  the  test,  for  it  came  after  the  siege  of  exams  for  Avhich 
I  did  my  own  work  besides  a  couple  of  days  of  hard  tutoring. 
This  much,  at  any  rate,  is  positive  :  There  was  no  decrease 
of  mental  power  resulting  from  the  experiment.  I  was  no 
more  tired  al  the  close  of  last  year  than  I  was  at  the  close  of 
the  year  before.  After  a  week's  rest  I  felt  quite  normal  and 
then  did  considerable  mental  work  all  summer. 


36  Fisher — The  Effect  of  Diet  on  Endurance. 

E.  (March)  "  Working  power  improved.  Can  concentrate  atten- 
tion for  a  longer  time." 
(June)  "  I  accomplished  a  greater  amount  of  mental  work  than 
in  previous  years  during  the  corresponding  period  of  the  col- 
lege year,  I  do  not  think  that  my  feeling  of  fitness  for  it 
was  any  greater,  however,  and  I  cannot  say  that  my  experi- 
ence of  fatigue  after  the  work  was  any  less.  I  learned  to  eat 
slower  than  had  been  my  custom  during  previous  years. 
Though  not  subject  to  indigestion,  I  experienced  less  stomach 
disorders  during  the  period  of  the  experiment." 

Lq.  (March)  "  I  have  put  in  more  long  hours  during  this  term 
than  any  previous  term,  consequently  have  had  a  good  deal 
less  sleep.  I  do  not  know  that  I  can  work  any  better,  except 
that  I  can  work  a  longer  period  at  one*  time  without  feeling  so 
tired  from  it." 
(June)  "  Of  course  a  great  deal  of  the  extra  work  was  outside 
work  which  was  an  extra  tax.  I,  however,  did  a  great  deal 
more  work  on  papers  that  I  prepared  than  I  ever  had  before. 
.  .  .  Although  I  spent  longer  hours  than  before  I  did  not 
feel  the  effect  of  the  work  so  much  as  before." 

Lw.  (March)  "  Have  been  working  harder  during  the  past  four 
months  and  have  taken  less  exercise  than  at  any  other  equal 
period  during  past  2|^  years.  The  character  of  the  work  has 
been  so  different  that  I  am  unable  to  say  whether  there  is  any 
increase  in  working  power,  but  I  find  that  I  rest  up  very 
quickly  after  becoming  tired  (mentally), 

"  When  March  tests  were  taken  I  did  not  feel  as  '  fit'  for  test 
on  that  particular  day  as  at  time  of  January  tests.  Had  been 
working  hard  and  had  been  under  nervous  strain,  which  un- 
doubtedly affected  the  tests." 
(June)  "  I  have  worked  harder  from  January  to  June  than  ever 
before,  and  have  taken  less  exercise.  As  my  mental  woi*k  Avas 
so  different  from  that  previous,  I  cannot  form  an  estimate  of 
any  increase  or  decrease  in  efiiciency,  but  as  I  have  said 
before,  I  always  rested  up  more  quickly." 

M.     (March)     ''  I  think  on  the  whole  a  slight  improvement." 
(June)     "Do  not  notice  any  change." 

P.  (March)  "  I  have  never  worked  so  steadil}^,  or  with  so  little 
necessity  to  exercise  the  will  to  work,  as  in  the  central  six 
weeks  of  the  test.  The  work  I  was  doinsr  was  chieflv  research 
in  the  Library,  poring  for  three  or  four  hours  at  a  time  over 
old  records — not  labor  of  the  most  interesting  kind." 


Ji^is/ier — yVte  Efi'ect  of  Diet  on  Enchtrance.  37 

(June)  ^[y  work  lioiii  Miiii-h  to  .lune  was  of  a  moiv  confining 
sort  than  ever  before  in  tlie  s[)ring.  From  Marcli  to  tlie  Easter 
recess  I  was  occupied  with  lil)rary  research  ;  from  Easter  on  I 
was  engaovd  on  an  essay  aii<l  tlu'  marking  of  some  2G0  Social 
Conditions  tlieses.  On  these  hist  I  spent  considerably  more 
tiincand  eti'ort  than  in  tlie  pri'ceding  year.  Thus  my  work 
was  liarder  and  more  tinu'-tilling  th;>n  usual.  I  had  much  less 
out-door  exercise  than  in  previous  s])rings,  and  missed  that 
relaxation  from  effort  which  all  j)rior  springtimes  have  bred. 
Vet  there  Avas  no  feeling  of  overwork,  or  even  of  work  as  a 
burden,  till  the  first  of  June.  From  then  on  I  did  feel  tired, 
and  examination  time  found  me  with  a  mind  very  difficult  to 
kiep  in  harness.  Undoubtedly  I  had  over-pushed  myself,  but 
did  not  realize  it  till  June.     .     . 

K.     (March)     Felt  an  increase  in  efficiency. 

(June)  My  power  for  mental  work  Avas  greater  between  the 
March  and  June  tests  than  between  the  January  and  March 
tests  and  the  latter  was  greater  than  before  the  experiment 
began  in  January.  I  can  state  Avithout  hesitation  that  my 
mental  working  power  increased  in  consequence  of  "  Fletclier- 
izing." 

'r.  (March)  Felt  that  he  had  at  least  held  his  OAvn,  but  "  surprised 
to  find  that  every  one  of  my  tests  (physical)  had  improved." 
For  the  first  test  came  after  the  rest  and  recreation  of  the 
winter  holidays  when  he  "  was  in  splendid  condition.  Since 
then  I  have  had  to  work  extremely  hard  Avith  little  regular 
exercise  and  rarely  in  bed  before  about  midnight."  Surprised 
also  that  the  mental  test  shoAA^ed  no  improvement,  probably 
because  "  the  confusion  around  me  Avas  considerably  greater 
than  in  the  first  test."  Can  do  his  ordinary  mental  Avork 
faster  than  before,  though  not  sure  that  he  can  Avork  longer. 
(June)  "  I  consider  I  did  more  work  last  year  during  the  period 
of  the  experiment  than  an}'  other  year.  During  the  Avhole 
nine  months  of  the  college  year  I  was  practically  Avorking  up 
to  my  limit  of  endurance.  I  did  not  grow  sleepy  as  early 
evenings  as  previous  years  and  my  attention  Avas  not  as  easily 
distracted  from  my  work  as  previous  years. 

"The  lack  of  imi)rovement  in  the  second  mental  test  may 
have  been  due  largeh'  to  the  fact  that  I  was  mentally  fagged 
out  after  the  examinations  and  Avas  feeling  the  need  of  my 
holidavs." 


38  Fisher — The  Effect  of  Diet  on  Endurance. 

W.    (March)    No  definite  impression  either  of  gain  or  loss. 

(June)  ' "  On  the  whole  I  felt  quite  as  workish  as  ever  I  did  in 
the  spring  months  and  did  not  feel  the  hot  days  as  much  of 
a  drag  as  usual." 

As  to  illness,  in  the  course  of  the  experiment  there  were  the  usual 
winter  colds,  though  appai'ently  these  were  less  common  than  before. 
One  man  had  grip  for  a  few  days,  another  the  mumps,  and  several  had 
constipation.  In  general,  the  men  expressed  themselves  as  better 
than  usual  and  in  some  cases  they  were  very  enthusiastic.  None  of 
the  ailments  suffered  by  the  men  were  ascribable  to  the  test  itself, 
unless  it  be  a  case  of  what  appeared  to  be  slight  rheumatic  sensations 
of  T.,  who  had  always  been  a  heavy  meat-eater,  and  who  during  the 
experiment  introduced  at  first  much  acid  fruit.  That  the  acid  in 
conjunction  with  the  high  proteid  might  occasion  such  symptoms  is 
at  least  consistent  with  some  of  the  numerous  theories  of  rheuma- 
tism.    On  avoiding  ver^^  acid  fruits  he  soon  lost  all  these  symptoms. 

The  following  extract  from  the  diary  of  B.  is,  I  think,  typical  of 
the  facts  in  this  respect  to  general  health  :  "  Have  now,  March  23, 
slight  sore  throat.  In  regard  to  colds,  I  have  been  troubled  less 
this  year  than  at  any  time  for  years  ;  but  this  fact  may  be  due  to 
great  change  in  climate,  Nebraska  to  Connecticut.  Have  usually  had 
colds  more  or  less  ail  winter  ;  therefore  my  freedom  has  been  indeed 
remarkable.  From  September  last  till  the  beginning  of  the  experi- 
ment I  experienced  frequent  attacks  of  indigestion,  'heart-burn.' 
Have  been  almost  free  from  that,  though  two  or  three  times  I  had  the 
same  experience  after  eating  bananas." 

Summary. 

The  phenomena  observed  during  the  experiment  may  be  summar- 
ized as  a  slight  reduction  of  total  food  consumed,  a  large  reduction 
of  the  proteid  element,  especially  for  flesh  foods,  a  lessened  excretion 
of  nitrogen,  a  reduction  in  the  odor,  putrefaction,  fermentation 
and  quantity  of  t\\k  feces,  a  slight  loss  of  weight,  a  slight  loss  of 
Strength,  an  enormous  increase  of  physical  endurance,  a  slight 
increase  in  mental  quickness.  These  phenomena  A'aried  somewhat 
with  different  individuals,  the  variations  corresponding  in  general  to 
the  varying  degree  in  which  the  men  adhered  to  the  rules  of  the 
experiment. 

That  we  are  correct  in  ascribing  the  results,  especially  in  endur- 
ance, to  dietetic  causes  alone,  cannot  reasonably  be  doubted  when  it  is 
considered  that  no  other  factors  of  known  significance  were  allowed 


Fisher — llie  J\fect  of  Diet  on  Endurance.  39 

to  aid  ill  tliis  rosiilt.  On  the  contrary,  so  far  as  the  operation  of 
other  fac!tors  was  couceriietl,  these  must  have  worked  against  rather 
than  for  the  results  achieved.  Exercise  was  in  no  case  indulged  in 
to  a  greater  extent  than  hail  previously  been  the  custom,  and  in  most 
cases  it  was  less.  Tlie  men  were  warned  not  to  take  up  exei'cise, 
except  so  far  as  they  had  l)een  accustomed  to  before  tlie  experiment 
began,  and  if  they  varied  their  exercise  at  all.  to  U'sseii  rather  than 
increase  it.  They  were  very  conscientious  on  this  ))oint,  as  on  others, 
— so  much  so  that  some  of  them  at  first  gave  up  exercising  until  they 
began  to  feel  "logy."  This  over-zeal  was  corrected  ;  but  in  no  case 
have  I  reason  to  think  that  the  exercise  taken  was  more,  or  more  S3'^s- 
tematic,  than  previously.  M.  was  probably  the  most  s^'stematic  in 
taking  exercise.  His  statement  on  this  point,  as  previously  given, 
the  reader  may  care  to  review. 

The  men  did  not  practice  on  the  endurance  tests  between  times. 
This  was  expressly  forbidden,  and  the  men  were  too  trustworthy  to 
admit  of  a  doubt  on  this  point.  The  tests  themselves,  needless  to 
say,  were  too  far  apart  to  have  given  any  chance  for  repetition  to 
give  "  knack,"  and  were  too    severe    to  count    as  beneficial  exercise. 

Nor  were  the  men  more  reofular  in  their  hours  of  retiring  or  other 
habits.  On  the  contrary',  they  were  rather  more  reckless  in  burning 
the  midnight  oil.  It  developed  that,  with  their  increased  freedom 
fi'om  fatigue,  they  indulged  more  freely  than  ever  their  propensity 
to  work  in  the  lines  of  their  respective  ambitions.  At  first  they  felt 
justified  in  doing  this,  as  it  accorded  with  their  instructions  not  to 
remove  any  handicaps  to  their  chance  of  improving  their  endurance, 
but  to  increase  rather  than  decrease  such  handicaps.  But  this  liberty 
l)ecame  license,  and  1  was  forced  to  remonstrate  with  the  men  for 
their  late  hours  arid  overstudy,  which  tended  to  rob  them  of  their 
surplus  endurance  almost  as  fast  as  it  accrued.  Long  before  the 
experiment  was  finished  the  men  had  given  every  appearance  of 
improved  working  power,  but  I  was  not  at  all  sure  that  they  would 
have  any  of  it  left  to  show  in  the  final  test,  because  of  their  tendency 
to  use  it  up  in  work.  Had  the  extent  of  their  working  proclivities 
been  realized  in  advance,  it  is  doubtful  if  the  experiment  would  have 
been  undertaken  at  all.  It  should  be  stated  that  all  except  M.  were 
graduate  students,  and  almost  all  of  them,  in  addition  to  their  uni- 
versity work,  were  earning  their  own  way. 

The  advance  of  warm  weather  must  have  tended,  had  not  their 
diet  counteracted  it,  to  tire  the  men,  if,  at  least,  Ave  may  trust  com- 
mon impressions  as  to  "  spring  lassitude." 


40  Fisher — The  Effect  of  Diet  on  Endurance. 

Again,  the  conditions  immediately  preceding  the  March  and  June 
tests,  as  compared  witli  those  preceding  the  January  test,  were  such 
as  to  give  the  advantage  to  the  January  test.  The  latter  came  soon 
after  the  Christmas  holida3's,  when  the  men,  as  they  themselves 
stated,  felt  refreshed  and  at  their  best,  whereas  the  March  test  came 
just  before  the  Easter  recess,  after  a  hard  term's  work,  and  the  June 
tests  came  after  a  like  period  of  hard  work, — in  some  cases,  as  of  B. 
and  R.,  immediately  after  exhausting  examinations. 

Finally,  the  tests  themselves  were  serious  drains  on  vitality.  Each 
required  a  period  of  from  several  days  to  two  weeks  for  recuperation, 
and  each  robbed  the  men  temporarily  of  several  pounds  of  weight. 
The  cookless  diet  experiment  for  six  days  also  cost  something  to 
those  who  took  part  in  it. 

In  addition  to  the  tests  mentioned  in  this  report  was  one  on  Jan- 
uary 23  of  leg-raising,  deep  knee-bending  and  arm-stretching,  taken 
after  a  night  from  which  two  hours  of  sleep  were  purposely  cut  off. 
After  consideration,  it  was  decided  not  to  repeat  this  test  as  being 
top  fatiguing.  It  therefore  has  been  omitted  from  this  report  ;  but 
it  added  one  more  burden  for  the  men. 

When,  therefore,  we  observe  the  known  handicaps, — the  over-study, 
the  strain  of  the  tests,  the  advance  of  warm  weather,  the  fact  that 
the  first  test  came  after  rest  and  the  other  tests  after  work,  and 
when  we  are  unable  to  find  any  other  cause  than  diet  — such  as  exer- 
cise, regularity  of  bed-tirne  or  other  habits  —  we  are  forced  to 
conclude  that  the  only  causes  which  produced  the  endurance  were 
dietetic. 

Possibly  some  persons  may  be  disposed  to  find  a  convenient  escape 
from  this  conclusion  b}^  ascribing  the  improvement  to  suggestion. 
Under  this  theory,  the  men  improved  because  they  expected  to.  It 
is  quite  true  that  there  may  be  more  force  in  autosuggestion  than 
most  of  us  realize.  But,  fortunately,  for  the  present  case  we  scarcely 
need  to  argue  the  point ;  for  as  a  matter  of  fact  it  was  not  true  that 
all  of  the  men  expected  to  improve.  This  was  certainly  not  true 
before  the  March  test.  In  fact,  the  men  were  about  equally  divided 
in  their  predictions  as  to  the  outcome,  and  used  to  have  animated 
discussions.  Yet,  both  the  confident  and  the  skeptic  faction  im- 
proved in  endurance  in  the  March  test  ;  and  so  far  as  I  am  acquainted 
Avith  their  prognostications  and  have  noted  their  improvement,  there 
was  little  if  any  correlation  between  those  prognostications  and  their 
improvement. 

It  is  of  course  still  possible  that  some  unobserved  element  has  crept 


Fisher — The  Ff'ect  of  Diet  on  Endurance.  -tl 

into  the  case,  to  which,  and  not  to  the  diet,  the  imi)rovement  in 
endurance  was  due ;  hut  in  view  of  all  the  facts  recited,  this  is 
extremely  Improbable.  What  slight  doubt  remains  should  be  resolved 
by  further  studies.  I  earnestly  hope  that  other  and  more  careful 
studies  may  be  made  by  more  competent  investigators  than  I. 

We  conclude  that  the  improvement  in  endurance  was  exclusively 
due  to  dietetic  causes.  The  only  dietetic  causes  at  work  were(l)' 
thorough  mastication,  (2)  implicit  obedience  to  ai)petite,  (3)  (during 
the  second  half  of  the  experiment)  when  appetite  did  not  clearly 
determine  the  choice,  the  voluntary  selection  of  the  non-flesh  and 
low-proteid  foods,  and  (4)  an  ample  variety  of  good  foods,  well 
cooked. 

So  far  as  cooking  is  concerned,  this  cause,  as  has  been  said,  entered 
unintentionally.  But  there  is  no  evidence  that  it  was  a  prime  factor 
in  the  experiment,  while  there  is  some  evidence  to  the  contrary. 
Thus,  E.,  who  especially  remarked  the  culinary  virtues  of  the  cook 
and  who  missed  her  services  more  than  any  one  else  during  the  brief 
period  of  her  absence,  was  the  one  member  of  the  club  who  failed  to 
im|)rove  in  endurance. 

If  we  allow  ourselves  to  speculate  as  to  the  changes  in  the  charac- 
ter of  diet  which  were  produced  hx  thorough  mastication,  we  may 
<lraw  an  inference  from  the  fact  that  the  carnivorous  animals  are  fast- 
eaters,  Avhereas  the  grain-eating  animals  are  slow-eaters.  It  would 
seem,  therefore,  when  man  changes  his  habits  from  fast  eating  to 
slow  eating  he  naturallv  chancres  his  food  from  the  food  of  a  fast- 
eating  to  that  of  a  slow-eating  animal.  The  question,  therefore, 
which  is  the  natural  food  for  man,  may  possibly  be  associated  with 
the  (juestion,  which  of  the  tAvo  methods  of  eating  is  natural  to  man. 
Was  the  slow  eating  of  the  nine  men  an  artificial  and  unnatural  |)rac- 
tice,  as  would  be  indicated  from  the  fact  that  the  majority  of  men 
eat  far  faster  '?  Or,  are  the  ordinary  habits  of  man  in  respect  to  the 
manner  of  fast  eating  themselves  unnatural  ?  I  have  not  attempted 
to  gather  the  facts  necessary  to  solve  this  problem,  but  it  certainly 
constitutes  an  interesting  one  for  the  physiologist  and  anthropologist. 
The  few  facts  upon  which  I  have  chanced  to  fall  Avould  seem  to 
indicate  that  man  is  naturally  a  slow  eater,  and  that  the  hurry-habit 
to  which  most  of  us  are  prone  is  a  consequence  of  the  artificial  high- 
pressure  to  which  modern  civilization  has  subjected  us.  Certain  it  is 
that  the  conditions  which  give  rise  to  quick-lunch  counters  and  to  the 
short  stops  of  trains  for  refreshments,  were  produced,  not  in  order  to 
meet  any  natural  propensity  to  eat  fast,  but  on  the  contrary,  in  the 


42  Fisher — The  Effect  of  Diet  on  Endurance. 

interest  of  the  more  rapid  transaction  of  business,  with  which  meal- 
times are  regarded  as  an  interference. 

We  may  therefore  at  least  conclude  that  whatever  the  speed,  of 
eating  which  is  natural  to  the  human  animal,  his  actual  speed  under 
civilized  conditions  is  greater  than  natural.  It  is  noteworthj^  also 
that  children  are  very  deliberate  in  eating  their  cookies.  It  is  only 
after  they  are  reproved  for  keeping  their  elders  waiting  that  they 
begin  to  imitate  the  latter  and  bolt  their  food.  Dr.  Higgins  *  and 
Dr.  Hasse  °  have  pointed  out  also  some  physiological  considerations, 
based  on  the  anatomy  of  the  human  throat  compared  with  the 
throats  of  the  carnivores  and  of  "  poltophagic"  animals,  which  would 
indicate  that  man,  to  a  large  extent  at  least,  is  naturally  a  slow-eating 
animal.  Dr.  Henrj^  Campbell  ^  has  also  given  some  evidence,  based 
on  a  study  of  the  primitive  tribes,  to  show  that  chewing  is  more 
thorough  among  uncivilized  races,  and  that  the  hurry  habit  to  which 
we  are  accustomed  is  largely  promoted  by  the  use  of  prepared  and 
'  mushy  "  foods, — which,  in  fact,  apj^ear  to  have  been  devised  ex- 
pressly for  the  purpose  of  being  quickly  swallowed. 

The  evidence,  however,  on  the  natural  food-habits  of  man  is  as  yet 
very  meager,  and  it  is  only  provisionally  that  we  may  consider  the 
thorough  mastication  advocated  by  Mr.  Fletcher  as  "  natural."  With 
this  reservation  we  may  say  that  the  expei'iment  here  described  may 
be  called  an  experiment  in  natural  eating,  or  an  effort  to  restore  a 
blunted  or  lost  food-instinct,  so  that  it  may  serve  as  a  safe  guide  to 
the  proper  quantities  and  kinds  of  foods.  If  it  be  asked  in  what 
way  this  natural  eating  tended  to  improve  endurance,  whether  it  was 
because  of  the.  finer  sub-division  of  food  through  mastication  ;  the 
increased  "  insalivation  "  ;  the  increased  flow  of  "  appetite  juice  "  ; 
the  better  adaptation  of  foods  to  the  particular  needs  of  the  individual 
and  the  moment  ;  the  lessened  quantity  of  food  ;  the  lessened  proteid  ; 
or  the  lessened  amount  of  flesh  foods,  no  satisfactory  answer  can  be 
given,  although,  as  the  previous  discussion  shoAvs,  there  is  more  or 
less  evidence  on  some  of  these  points.  There  are  certainlj^  some  very 
fascinating  problems  for  the  physiologist  to  solve  in  regard  to  fatigue 
as  related  to  diet.  Are  the  "fatigue  poisons"  due,  for  instance, 
chiefly  to  the  combustion  of  proteid  in  excess  of  the  physiological 

'  See  Humanicultiu-e,  N.  Y.     Stokes,  1904. 

2  See  Archiv  fur  Anatomie  (Waldeyer's)  1905,  p.  321. 

*  ''Observations  on  Mastication,"  London  Lancet,  Jiily  11,  18,  25  and  Aug.  8, 
1903.  Reprinted  in  Horace  Fletcher's  The  A.  B.-Z.  of  Our  Own  Nutrition, 
Stokes,  1903.      See  pp.  126-135. 


Fisher — IVw  Ejfect  of  Diet  on  Endurance.  43 

needs,  as  the  theory  of  CMiittenden  would  ex])laiii  them  ?  Or,  are  they 
largely  due  to  the  inucstiou  of  these  poisons  with  Hesli  foods,  as  tlie 
vet^etarians  and  Dr.  llaig  liave  maintained  ?  Or,  do  both  exphiua- 
tions  liave  a  share  ? 

The  results  of  the  experiment  demonstrated  so  great  an  increase 
of  endurance  as  to  seem  at  first  incredible.  It  certainly  was  a  sur- 
prise, both  to  the  nuMi  and  to  nu'.  But  statistics  which  I  have  been 
eollecting  during  the  last  two  years  have  prepared  me  to  find  great 
differences  and  changes  in  endurance.  The  s])ecial  result  of  the 
present  exjieriment  is  to  show  that  diet  is  an  important  factor  in 
producing  such  alterations.  The  fact  that  endurance,  even  among 
l>ersons  free  from  disease,  is  one  of  the  most  variable  of  human  fac- 
ulties— far  more  variable  than  strength,  for  instance — is  evident  to' 
any  one  who  has  made  even  a  superficial  examination.  Some  persons 
are  tired  bv  climbing  a  flight  of  stairs,  whereas  the  Swiss  guides, 
throughout  the  summer  season,  da}'  after  day  spend  the  entire  time 
in  climbing  the  Matterhorn  and  other  peaks  ;  some  persons  are 
'•winded"  ])y  running  a  l)lock  for  a  street  car,  whereas  a  Chinese 
coolie  will  run  for  hours  on  end  ;  in  mental  work,  some  persons  are 
unable  to  apply  themselves  more  than  an  hour  at  a  time,  whereas 
others,  like  Humboldt,  can  work  almost  continuous!}'  through  eight- 
een hours  of  the  da}'.  Among  statistics  gathered  independently  of 
the  present  experiment,  I  have  found  measurable  differences  between 
persons  far  greater  than  the  change  of  endurance  of  the  eight  students 
which  we  have  seen.'  Among  some  50  tests  of  different  pei'sons 
holding  their  arms  horizontally,  many  were  found  whose  arms  actually 
dropped  against  their  will  inside  of  ten  minutes,  whereas  several  were 
able  to  hold  them  up  over  an  houi*,  and  one  man  held  them  3  hours 
and  20  minutes,  or  a  round  200  minutes,  and  then  dropped  them 
voluntarily.  Similarly  with  deep  knee-bending,  some  persons  were 
found  physically  unable  to  rise  again  from  the  stooping  posture  after 
accomplishing  less  than  500  bendings,  whereas  several  succeeded  in 
stooping  1,000  times,  and  in  one  case,  2,400.  Again,  in  leg-raising, 
the  legs  positively  refused  to  rise  to  the  vertical  in  some  cases  before 
40  times  were  reached,  Avhereas  in  two  cases  this  motion  was  per. 
formed  1,000  times  or  over.  On  the  new  ergograph  previously 
referred  to,  among  the  1(3  j)reliminary  tests  there  was  a  range  in 
endurance  between  different  persons  from  18  to  145  and  in  the  same 
person  at  different  times  from  29  to  110. 

'  For  an  account  of  some  of  these  statistics  see  "  The  influence  of  flesh-eating  on 
endurance."     Yale  Medical  Journal,  March,  IflOT. 


44  Fisher — The  Effect  of  Diet  on  JEndurance. 

It  is,  to  say  the  least,  remarkable  that  hitherto  so  little  effort  has 
been  directed  toward  discovering  the  factors  which  explain  such 
differences  in  endurance.  That  exercise  is  one  of  the  most  and  per- 
haps the  most  important  factor  has  alone  been  recognized.  A 
correspondent  assures  me  that  by  means  of  moderate  re^i^/ar  exercise 
he  succeeded  in  increasing  his  endurance  between  100  and  200^  in 
three  weeks  as  measured  by  leg-raising  and  "  dipping. "  The 
influence  of  diet  has  always  been  regarded  as  small  or  negligible,  and 
the  opinion  has  been  almost  universal,  until  recently,  that  a  diet  rich 
^n  proteid  promotes  endurance.  Even  among  those  whose  researches 
have  led  them  to  the  opposite  conclusion,  there  is  very  little  concep- 
tion of  the  extent  to  which  diet  is  correlated  with  endurance.  Such 
a  person,  a  medical  friend  of  the  writer,  stated,  when  the  present 
experiment  was  planned,  that  he  did  not  think  the  dietetic  factor  strong 
enough  compared  with  others  to  produce  any  marked  effect.  We 
have  all  heard,  of  course,  of  the  enthusiastic  reports  of  vegetarians 
as  to  their  increased  endurance,  but  these  we  have  discounted  as 
exaggerations.  The  result  of  the  present  experiment,  however, 
would  seem  to  indicate  that  one's  improvement  in  endurance  is  usuall}^ 
not  less,  but  greater,  than  he  himself  is  aware  of.  Probably  it  is 
also  true  that  we  may  lose  a  large  fraction  of  our  working  power 
before  we  are  distinctly  conscious  of  the  fact. 

While  the  results  of  the  present  experiment  lean  toward  "  vegeta- 
rianism," they  are  only  incidentally  related  to  that  propaganda. 
Meat  was  by  no  means  excluded  ;  on  the  contrary,  the  subjects  were 
urged  to  eat  it  if  their  appetite  distinctly  preferred  it  to  other  foods. 

The  sudden  and  complete  exclusion  of  meat  is  not  always  desir- 
able, unless  more  skill  and  knowledge  in  food  matters  are  employed 
than  most  persons  possess.  On  the  contrarj^,  disaster  has  repeatedly, 
overtaken  many  who  have  made  this  attempt.  Pawlow  has  shown 
that  meat  is  one  of  the  most  and  perhaps  the  most  "peptogenic" 
of  foods.  Whether  the  stimulus  it  gives  to  the  stomach  is  natural,  or 
in  the  nature  of  an  improper  goad  or  whip,  certain  it  is  that  stomachs 
which  are  accustomed  to  this  daily  whip  have  failed,  for  a  time  at 
least,  to  act  when  it  was  withdrawn. 

Nor  is  it  necessary  that  meat  should  be  permanently  abjured,  even 
when  it  ceases  to  become  a  daily  necessity.  The  safer  course,  at  least? 
is  to  indulge  the  craving  whenever  one  is  "  meat  hungry,"  even  if,  as 
in  mau}^  case-^,  this  be  not  oftener  than  once  in  several  months.  The 
rule  of  selection  employed  in  the  experiment  was  merely  to  give  the 
benefit  of  the  doubt  to  the  non-flesh  food  ;  but  even  a  slight  preference 
for  flesh  foods  was  to  be  followed. 


FisJier — The  Eff-ect  of  Diet  on  Endurance.  45 

lender  flesh  foods  are  iiieliuk'd  all  meat-  and  "  stock-"  sou[)S.  It 
has  been  shown  that  althoiiij^h  these  extracts  of  meat  contain  a  large 
amount  of  nitrogen,  it  is  not  in  the  form  of  proteid  which  can  be 
utilized,  but  only  of  waste  nitrogen  which  must  be  excreted.  Ap- 
parently the  sole  virtue  of  sucli  soups  is  that  they  supply  the  ''  pepto- 
genic'"  stimulus  above  referred  to. 

The  experiment  will  be  seen  to  harmonize  with  and  supplement  the 
experiment  of  Professor  Chittenden,  on  which  it  was  founded  ;  but 
the  objects  of  the  two  experiments  were  quite  different.  Professor 
Chittenden's  was  aimed  to  ascertain  the  pliysiological  requirements 
as  to  proteid,  and  did  not  touch  upon  the  question  of  endurance. 
Moreover,  Professor  Chittenden,  in  order  the  better  to  measure  the 
proteid  and  nitrogen,  artificially  reduced  the  quantities  ingested, 
whereas  in  the  })resent  experiment,  test  was  made  of  Mr.  Fletcher's 
claim,  that  thorough  mastication  leads  naturally  to  the  adoption  of 
the  physiological  amount  of  proteid.  This  we  found  to  be  true,  espe- 
cially after  the  introduction,  at  the  middle  of  the  test,  of  the  susrsres- 
tion  that  when  appetite  was  in  doubt,  the  lower  proteid  foods  should 
be  selected.  But  the  tendency  Avas  quite  marked  during  the  first 
period  also,  and  might  have  been  expected  to  lead  to  the  same  results 
without  the  introduction  of  even  the  suggestion  of  voluntary  choice, 
had  the  experiment  been  long  enough.  This  was  the  experience  of 
others,  notably  Mr.  Fletcher  himself,  whose  case,  in  fact,  first  called 
Professor  Chittenden's  attention  to  the  possible  virtues  of  low 
proteid. 

The  practical  value  of  the  experiment  consists  in  the  fact  that  any 
layman  can  apply  it,  with  or  without  a  knowledge  of  food  values, 
though  with  more  advantage  if  he  possesses  than  if  he  lacks  such 
knowledge. 

If  the  dietetic  rules  of  the  present  experiment  are  followed,  no  self- 
denial  as  to  foods  is  required.  It  is,  however,  absolutely  necessary 
that  there  should  be  self-control  enough  to  break  up  the  habit  of 
hurried  eating  to  wdiich  modern  civilization  has  brought  us,  habitu- 
ating us,  as  it  does,  to  eat  against  time. 

Experience  indicates  that  appetite  does  not  lead  to  a  diet  fixed  in 
amount  or  constituents,  but  moves  in  undulating  waves  or  cycles. 
The  men  who  took  part  in  the  experiment  were  encouraged,  after 
any  of  the  symptoms  which  seemed  to  be  associated  with  high  pro- 
teid (such  as  heaviness,  sleepiness,  stiffness  or  soreness  after  exer- 
cise, or  catching  cold),  to  cut  down  on  their  proteid  and  substitute 
fat  to  restrain  the  gastric  juice.     This  advice  was  intended  to  make 


46  Fisher — The  Effect  of  Diet  on  Endurance. 

application  of  the  theories  of  Foliii'  that  we  usually  cany  a  reservoir 
of  proteid,  enough  to  supply  our  needs  for  body-building  for  a  fort- 
night. If  this  reserv^oir  is  exhausted,  proteid  starvation  occurs  and 
the  body  feeds  on  itself  ;  if  it  is  filled  too  far  it  overflows  and  causes 
the  evils  of  excessive  proteid.  If  this  theory  is  correct,  the  art  of 
eating  may  consist  largely  in  maintaining  a  golden  mean  such  that 
the  proteid  reservoir  is  neither  empty  nor  overflowing,  or  at  any  rate, 
not  overflowing  much.  Many  persons  fear  to  reduce  their  proteid  to 
the  Chittenden  minimum  for  fear  of  i^roteid  starvation.;  but  the 
experience  of  those  who  have  tried  it  would  seem  to  show  that  this 
fear  is  groundless,  provided  no  violence  is  done  to  natural  appetite. 
This  may  be  trusted,  so  it  would  appear,  to  raise  a  warning  in  the 
form  of  "  nitrogen  hunger  "  before  the  danger  point  is  reached. 

'"A  Theory  of  Protein  Metabolism."'     American  Journal  of  Physiology,  March, 
1905. 


2_ 


A  GRAPHIC  METHOD  IN  PRACTICAL 

DIETETICS 


llMl  N  (i     F  r  STIEE,     Pji.I). 

rri)t"('sPoi'  of  I'olltical  Economy,  Yalo  Univorslty,  and  Secretary  of 
the  Xew  Haven  County  Antituberculosis  Association 

NEW    HAVEX^    CONN". 


Reprinteil  from  The  Journal  of  the  American  Medical  Association 
Api-il  20,  1907,   Vol.  XLVin,  pp.  1H16-1324 


Copyright,   1011 

A.MKRir.W    MKDlCAri    ASSOCIATION' 

FivK  IlrNur.rn  axd  Tniiny-FivE  Dkarboex  Avenue 
CHICAGO 

PRiri:.  in  Cents 


I 


A    GRArillC    ^lETHOD    IX    PILVCTICAL 
DIETETICS 


IRVING    FISHER,    I'li.!). 

Professor  of  Political   Kconomy,   Yale  University,   and   Secretary   of 
the  New  Haven  loanty  Antitubi  rculosis  Association 

NEW    llAVKN,   COXN. 


Professor  IMeiidel,  in  an  address  on  dietetics  before  an 
audience  of  Boston  physicians,  asked  the  very  pertinent 
question :  "\\  hy  do  physicians  take  so  much  care  in 
measuring  their  dosages  of  drugs,  which  are  adminis- 
tered only  occasionally,  and  so  little  care  in  measuring 
their  food  presciiptions,  which  are  to  be  followed  daily?" 
In  prescribing  diugs,  a  physician  wou'd  be  regarded 
as  ciiminally  negligent  if  he  simply  told  his  patients 
to  take  ''a  little''  strychnia,  but  to  be  sure  "not  to 
take  too  much ;"  or  to  take  a  "Vig  dose"  of  calomel. 
Yet  in  prescribing  diet,  physicians  often  give  just  such 
advice. 

Doubtless  in  the  scheme  of  Nature  man  was  not 
expected  to  measure  his  food.  He  was  provided  with 
healthy,  normal  instincts  instead.  But,  as  often  happens 
in  diseased  conditions,  the  food  instinct  has  sometimes 
become  perverted  and  cannot  be  trusted.  The  con- 
sumptive lequires,  or  at  any  rate  is  believed  by  most 
physicians  to  require,  more  food  than  his  appetite  calls 
for,  and  the  victim  of  kidney  diseases  less.  To  reestab- 
lish the  instinctive  guides  to  food  selection  should 
doubfess  be  the  ultimate  aim  of  the  physician;  but.  to 
that  end,  a  quantitative  determination  of  the  food 
actually  used,  and  a  quantitative  regulation  thereof,  may 
be  advantageously  employed.  As  yet.  however,  neither 
the  quantity  of  food  nor  the  piopoitions  of  its  constit- 
uents have  been  often  prescribed  with  precision. 

AM-.at  Dr.  Bui  ton-Fanning  says  of  prescribing  food 
for  the  consumptive  applies  to  food  prescriptions  in 
geneial,    that   the    whole    art    of    such    prescriptions    is 


3 


summed  i;p  in  the  word  acfuraey.^  Until  recently 
accuracT  was  impossible.  But  to-da}',  by  the  aid  of 
elaborate  tables  of  food  values  constrncted  by  Atwater 
and  Bryant  in  America,  and  of  mineral  salts  by  Koenig 
in  Germany,  and,  if  great  accuracy  is  required,  of  coeffi- 
cients of  digestibility,  it  has  become  possible  to  make  a 
true  measurement  of  diet  prescriptions. 

As  to  mineral  salts,  we  know  at  least  in  which  foods 
they  are  severally  to  be  found.  For  instance,  if  a 
patient  needs  iron,  he  may,  instead  of  taking  the  prep- 
arations of  the  druggist,  have  added  to  his  list  of  foods 
one  or  more  of  the  following:  lentils,  asparagus,  lettuce. 


C 


10      20     30     40     50     60     70      80     90    100 
Figuri'    1 


peas,  figs,  strawberries,  spinach,  beans,  potatoes,  prunes 
or  apples,  the  order  of  which  is  that  of  the  amount  of 
iron  contained  in  proportion  to  total  food  value. 

Again,  if  calcium  is  needed,  instead  of  limewater 
there  may  be  administered  milk,  figs,  cabbage  or  lentils. 
]f  sulphur  is  needed,  the  patient  may  be  given  potatoes, 
peas,  beans,  asparagus  or  cabbage;  if  phosphorus,  beans, 
peas,  rice,  milk;  if  silicon,  lettuce,  cabbage,  strawber- 
ries, rice,  potatoes,  barley  or  cucumbers ;  if  magnesium, 
peas,  beans,  cocoanuts,  barley  and  rice ;  if  chlorin. 
cocoanuts,  milk,  lentils,  asparagus,  cabbage;  if  sodium, 

1.  For  a  statement  of  the  groat  divergences  of  sanatoria  from 
tliis  ideal,  see  "Statistics  of  "Diet  in  Consumptive  Sanatoria." 
Fisher.  Tran.  Second  Annual  Meeting,  Nat.  Assoc,  for  Study  and 
rrevention  of  Tuberculosis,  New  Yorj;,  10(»7  :  also  in  Am.  .Tour,  of 
the   Med.   Sci.,   October,   1906. 


lontiliJ,  fi,<2;s.  asj)arnii:us ;  if  pota?pinin.  l)cans.  lentils, 
peas,  eoeoamits.  jiotatoes.  Or  if  simply  mineral  salts  in 
general  are  re<piireil,  tliev  are  found  in  lai-_>:e  (piantities 
in  jnoportion  to  food  value,  amonj;  lentils,  ]icas.  beans, 
eocoanuts,  ]^otatoes,  milk.  rice.  figs,  apples,  barley, 
eal)ba<ie  and  ebestnuts. 

There  are  data  also  wbi.-.li  (lesei'ibe  the  amount  and 
kinds  of  acids  in  foods,  their  ])e])togenic  (pialities,  their 
etfects  on  ]ieristalsis.  etc. 


rUsK   and  Ctrtalsi 


Oatmial  QcliJ  Sb 

rwur /Graham      jf,  _'^  ^ 
[Sraniard  gradr  SJ 

^ra<j,tii  37 ." 

yili"-t  drnd  /3  -    - 

C«rn   FttHfs  97  .  •  ^ 

Hommij  4  2  y 


,>«  r^ 


r-  I  ^  M   '  "  » 


Figure   2 


THE  BASIS   OF   CO:\rPUTATION" 

But  the  ordinar}^  problems  of  dietetics  are  concerned 
not  so  much  with  these  minor  constituents  and  proper- 
ties of  foods  as  with  the  amount  and  proportions  of 
proteids,  fats  and  carbohydrates. 

Two  methods  have  hitherto  been  used  for  computing 
])roportions  of  proteids,  fats  and  carl)ohydrates.  One 
consists  in  using  the  tables  of  percentages  by  weight  of 
]iroteids,  fats  and  carbohydrates ;  the  other,  Dr.  J.  H. 
Kellogg's,  in  using  a  table  which  gives  the  number  of 
calories  in  the  form  of  proteids.  fats  and  carl)ohydrates 
per  ounce  of  each  kind  of  food.    These  may  be  described, 


respectivel.y,  as  the  method  of  weioht  per  cent,  and  the 
method  of  calories  per  onnce.  The  method  here  sug- 
gested is  different  from  either,  and  may  he  called  the 
method  of  calories  per  cent.  It  takes  as  its  starting 
point  not  a  nnit  of  weight,  but  a  unit  of  food  value, 
called  a  "^standard  portion"  of  each  kind  of  food.  A 
"standard  portion"  is  defined  as  that  amount  of  food 
which  contains  100  calories.  A  table  is  constructed 
which  gives  the  weight  in  a  "standard  portion"  of  each 
particular  kind  of  food,  and  out  of  the  100  calories  con- 


suls  and  Fruits. 


Olatfriii/len  nj 
Bananei}  J  f  '  \ 


riunn  in  -  —  ~  _,  ^  '"^  '  ''    \    1  ' . 


I  a  o  o 


0 


<0  5> 

Fig'urc  3 


tained  therein  the  number  of  calories  in  the  form  of 
proteids,  fats  and  carbohydrates.  The  three  methods 
were  discussed  and  the  last-named  explained  in  detail  in 
another  paper.-  We  shall,  therefore,  pass  over  this  part 
of  our  subject  very  briefly  in  the  present  paper  and 
devote  our  main  attention  to  the  practical  application. 
In  order  to  carry  out  this  inethod,  foods  should  l)e 
served  at  the  table  in  "standard  portions"  or  simple 
multiples  thereof.     The  amount  of  milk  served,  instead 


2.  Fishei- :  "A  New  Method  for  Indicating  Food  Values,"  Amcr. 
Jour,  of  Physiol.,  April  1,  1906. 


(if  Ihmiil;  a  wliole  iiiinilici-  of  (Hiiirt's,  sIkhiM  lie  (  Inr  a\rr- 
a^o  milk)  t.!'  ^^ml•l';^ — tlio  amount  that  coiitaiiis  KM) 
calorirs.  This  •'stamhird  portion""  constitutrs  ahoiit  two- 
thirds  ot'  an  ordinal  \'  <ihiss  of  milk.  Of  the  liH)  t'alorios 
which  it  contains.  l!t  will  hi'  in  the  form  of  protcid.  52 
in  fal.  and  "i".'  in  carhnlivdratcs.  In  other  words,  of  the 
lood  valiii'  of  milk.  !!•  per  ccni.  is  ju'dtcid.  ')'i  per  cent. 
fat.  and   2!)  ])er  tent,  ^■arl)o!lydl■ates. 

()nc   advantao:^   of   tliis    mctliod    is   apparent    at    once, 
it    enahles   us    to    make    a    ii'iie  eonipaiison    heiweeii    (lif- 


ts. 


Ce/fr^  /?  -  —  ^ 
I-''""  en„3  ^)\ 
{^9  fianr  t^^ , 

Purnftf'n^  If ~.      "  ^ 
Oni  ens(f,nhi 

CortTigfTfrr>    \    —    - 


Figui-o  4 

ferent  foods  as  to  the  relative  amounts  of  ])roteid.  fat 
and  carholiydrate.  The  other  nietliods  are  misleadinir  in 
this  regard.  For  instance,  though  it  is  well  recognized 
that  milk  is  a  higher  ])roteid  food  than  ])eean  nuts,  yet 
if  we  compare  milk  and  the  pecans  on  the  l)asis  of  the 
method  of  "weight  per  cent.."'  we  shall  lind  tliat  the 
])ecans  ap|)ear  three  times  as  7'ich  in  proteid.  milk  con- 
taining 3.3  per  cent,  and  pecans  fl  i)er  cent.  But  if  we 
compare  them  oti  the  hasis  of  "calories  per  cent.."  we 
find  that,  while  milk  contains  19  calories  of  proteid  out 
of  each  100  of  total  calories,  pecans  contain  only  6.  milk 


6 


showing  three  times  as  much  proteid  as  pecans.  The 
paradox  that  pecans  are  higher  in  proteid  per  ounce  but 
lower  in  proteid  per  100  calories  is  due  to  the  fact  that 
pecans  are  a  much  more  concentrated  food  than  milk: 
whereas  100  calories  of  milk  weigh  4.9  ounces,  100 
calories  of  pecans  weigh  only  half  an  ounce.  The  weight 
of  a  '"standard  portion"  of  anv  food.  i.  e.,  of  that 
amount  which  contains  100  calories,  is  a  measure  of  the 

The  most  concentrated  of  all 
P 

PuddiTK^s.Pits  Paslriti,  Sorttts. 


degree  of  concentration 


Hone^  I  OS    ■ 
Afdpssn  Cane  12  • 
Tapioca  -?Si"-    \\ 
Tapioco Applet  32  -  ■'. 
hunt  Marmalade  22  ■■  . 
Oronulattdiuqar  /3fc- . 
Maple  su^jr  I'Z —  p 


I 
'  \ 


«M     \ 


v.  , 


i   £   C  cS   5-  |.~*   <^ 

•<  ^     5>,  Os;     *    V    ts 


S    <:»  >a 


^    <^    t:^ 


Figure  o 


foods  is  probably  olive  oil,  which  contains  100  calories 
in  a  little  over  one-third  of  an  ounce  (0.38  oz.).  "Water- 
melon represents  a  food  at  the  opposite  extreme,  of 
which  over  \y=>  pounds  are  required  to  yield  the  100 
calories.  In  order  that  the  '"'calories  per  cent.""  method 
may  be  easily  put  in  practice,  it  is  necessary  to  have  a 
table  giving  the  weight  constituting  a  ""standard  por- 
tion"" (i.  e..  the  amount  yielding  100  calories)  and  the 
calories  of  proteid.  fat  and  carbohydrate  in  this  portion. 


At  tlio  close  of  tlio  present  nrlicle  such  a  laltk-.is  ^iveii. 
eonipiited  chietly  frDiii  tlie  tables  of  AtwatiT  and  lii-vanl 
and,  for  made  dishes.  I'lnm  those  of  l)r.  K<•^o(r«.^  'UK- 
chief  advantatje  of  tins  method  of  expressing'  food'vahies 
is  that  it  lends  itself  readily  to  <,Maphic  representation. 
'J'lie  dillieulty  in  the  ])ia(tieal  use  of  most  tables  of  food 
values  is  that  they  cannot  he  visualized. 

THE    (iUAI'IIK      METHOD 

Different  foods  contain  the  tliree  food  elements,  pro- 
teids,  fats  and  carbohydrates,  in  different  pi'opoi-tions. 
The  tripartite  constitution  of  any  jiaiticular  food  is  rep- 


VthltftrEqf,  ty. 


Dairy  Products  .  f  ijc^s    atvA 
Mtat    Subst'vl  ute.5. 


4 


^1- V 


Glutrn  Cru//  7  3- 

^H\mmrd  NilK  »  4  - 
Bulttrmilli  9  7 ' 


CtHitnitd  N,lk  I  Ob 


figure  t; 

resented  in  the  present  method  by  the  position  of  a 
point  in  the  triangle^  CPF  (Fig.  1).  The  method  of 
locating  the  point  on  the  triangle  is  analogous  to  that  of 
locating  a  city  on  a  maj)  by  latitude  and  longitude;  the 
per  cent,  of  proteid*  in  the  food  is  represented,  like  lati- 
tude, by  the  height  of  the  point  above  the  base  line  CF 
(the  total  height,  CP,  being  taken  as  100  per  cent.). 
'J'he  percentage  of  fat  is  represented,  like  longitude,  by 
the  distance  of  the  point  horizontally  from  the  vertical 

?,.  YoT  ronvfnifncf.  the  triantrlo  is  drawn  with  one  angle,  C, 
a  right  angle  and  the  two  sides  about   it  e(|iial. 

4.  I  emi>loy  the  term  pioteid,  alllioiigh  in  the  tables  the  figures 
represent  "protein"  (i.  e.,  014  times  nitrogen),  the  usuai  malteshift 
for  proteid. 


8 


line  CP-  (the  total  horizontal  breadth,  CF,  being  taken 
as  100  per  cent.).  Thus,  the  point  0,  representing 
milk,  is  located  at  a  height  above  CF  ("latitude")  19 
per  cent,  of  the  total  height  of  the  triangle,  which  sig- 
nifies that  19  per  cent,  of  the  food  value  of- milk  is  pro- 
teid ;  and  at  a  distance  to  the  right  of  CP  ("longi- 
tude") 52  per  cent,  of  the  total  breadth  of  the  triangle, 
which  signifies  that  52  per  cent,  of  the  food  value  of 


Soups ,  Salctds  anA.Rellslies 


Cemtmme  se"/"  ^»-  — 


Cram  Chcndfr  dSf  ~    ' 
ffmato  Catiufi  b 


■^      •»      tM     ^ 

1 

1- 

■5       ^      ?      ^ 

^     •?     S     ^ 

^     ^    1    ^ 

> 

«r 

"0     i     ^     "^ 

o 

J 

liii 

1 

Figure 

7 

a  i.  "»  ^ 

c  o  *  V 

i  V  !  » 

o  5  5  * 


milk  is  fat.  Foods  liigh  in  ])roteid  will  be  represented 
by  points  high  up  in  the  triangle.  AVhite  of  egg.  of 
which  tlie  food  value  is  all  proteid,  will  be  represented 
at  the  ]joint  P,  representing  100  per  cent.  P  is,  there- 
fore, called  the  "proteid  corner"  of  the  triangle.  Foods 
rich  in  fats,  as  nuts,  cream,  butter,  are  represented  by 
]ioints  far  to  the  right.  Pure  fats,  like  olive  oil,  are 
located  at  F  at  the  extreme  right,  representing  100  per 
cent,  of  fat.     F  is,  therefore,  called  the  "fat  corner." 


T1)0  jxiiiit  ri'[)rc'Scnliii^U"  a  Uhh\  is  i-oiiipli'li'ly  located  liv 
means  of  the  ]icn-('iitauo  of  jnofcid  and  fat;  no  attiMitioii 
need  l)e  paid  to  the  eai-lidh vdrate.  If,  lidwexci'.  it  is 
desired  to  find  the  eailtoliydrate,  its  ])ereentago  is  lead- 
ily  deterniined.  l)ein<i-  what  is  left  (d'  I dd  calrn'ies  not 
alreadv  aceonnted  for  hv  proleid  and  lai.  Tliii-.  a 
"standard  portion"  of  eotta.ui'  ehet'se.  heiuL:'  ^<i  per  eeiii. 
pioteid  and  S  jier  cent,  fat,  will  have  left  Ki  pei'  eeiii.  n>' 
oarhohydiate.  If  one  desires  a  aiaphic  I'epi'eseiiial  ion. 
it  is  fiHind  in  the  distance  of  the  poiid  <)  from  the  tldid 
side  of  the  trianLile.    FP   (ilie  total  distance  of  thi<  side 


Classe.5  of  Foods. 


Jam  \ 

•  flartTialatUil  —  _ 


Figure   N 


fi'om  the  opposite  corner  l)einii'  taken  as  100  |)or  cent.). 
Foods  like  l)read.  cereals  and  frnits.  which  aio  mostly 
carbohydrate,  will  thns  be  represented  hy  points  far 
away  from  the  side  FP.  Foods  snch  as  snoar,  of  which 
the  food  value  is  wholly  carlxiliydrate.  ■will  he  repre- 
sented at  the  i-eiiiotot  ])oint  (V  representing  ino  per 
cent,  carbohydrate,  which  i<.  therefore,  called  the  "car- 
holiydrate  corner." 

Any  food  is  thus  lepresi'ntcd  on  the  "food  map"  hy  a 
jioint  tlie  relative  distances  of  which  from  the  three 
sides  of  the  trianiile  represent  the  proteid,  fat  and  car- 


10 


bolivdrate.^  On  this  food  may.  fatty  foods  are  repre- 
sented by  points  near  the  fat  corner.  F,  starchy  and 
saccharine  foods  by  points  near  the  carbohydrate  corner, 
C,  and  proteid  foods  by  points  near  the  proteid  corner. 
P.  A  food  devoid  of  proteid  is  evidently  located  on  the 
base  line  C;  a  food  devoid  of  fat,  on  the  side  CP, 
and  a  food  devoid  of  carbohydrate  on  PP.  The  chief 
classes  are  represented  in  the  accompanying  diagrams, 
flesh  foods  and  cereals  being  shown  in  Figure  2,  nuts 
and  fruits  in  Figure  3.  vegetables  in  Figure  4,  pud- 
dings, pies,  pastries  and  sweets  in  Figure  5,  dairy  prod- 
ucts, eggs  and  meat  substitutes  in  Figure  6,  and  soups, 


Butter 


0        10     20    30   40    50    60    70     80     90  100  f 

Figure  9 


salads  and  relishes  in  Figure  T.  In  each  case  the  posi- 
tion of  the  point  relatively  to  the  sides  of  the  triangle 
represents  the  proportions  of  the  proteids,  fats  and  car- 

5.  It  has  been  shown  elsewhere  (Amer.  Jour,  of  Physiol.,  April, 
1006.  pp.  422-4)  that  this  method  of  visunlizins  the  composition  of 
any  food  carries  another  method  with  it.  If  from  the  point  O 
(Fig.  1),  the  position  of  which  in  the  triangle  indicates  the  food 
composition  (of  milk  for  instance),  we  draw  straight  lines  to  the 
three  corners  of  the  triangle,  thus  resolving  the  triangle  into  three 
constituent  triangles,  it  may  be  shown  that  if  we  call  the  total 
area  of  the  triangle  100  to  represent  a  "standard  portion"  (100 
calories  I  of  the  food,  then  the  three  partial  triangles  will  exactly 
represent  the  constituents  for  proteid.  fat  and  carbohydrate.  The 
triangle  representing  proteid  is  COF,  i.  e.,  the  trianale  whose  alti- 
tude to  O  represents  proteid  in  the  first  method.  Similarly.  COP 
represents  fat.  and  POF  carbohydrate.  For  the  graphic  represen- 
tation of  particular  foods  by  this  method  of  triangles,  see  the 
article  alread.v  cited.  In  the  jiresent  article  onl.v  the  method  of 
lines  or.  as  we  may  call  it,  the  "latitude  and  longitude"  method  will 
be  employed. 


11 


Ixihydi all's,  and  l\\v  miiiilR'r  oppij-silo  each  nana'  ii'jiro- 
seiits  the  wei,alit  (in  ouni-os)  of  a  "standard  portion." 
'I'his  iiH'thod  of  r('])ivscntin<r  food  values  reveals  some 
strikinij  J'aots — for  instance,  the  great  variations  in  the 
jiroportioii  of  proteid  in  diiferent  vegetahles.  A'egetables 
are  eonunonly  suiijioscd  to  be  low  in  ])roteid.  This  is 
true  of  some  vegetables,  such  as  beets,  artichokes  and 
sweet  potatoes;  hut  others  are  high  in  pi-otcid  such  a< 
asparagus,  cabbage,  cauliflower,  celerv,  cueunihers,  egg- 
jilant,  radishes,  s]iinach,  squash  and  tomatoes."  Among 
fruits  also  we  find  some  instances  of  luoderatelv  higli 
j)roteid,  such  as  strawberries  and   UhukberriL's,  oranges 


10     20    30   40     50     60     70     80    90    100 


Figure   10 


and  -natermelon.  These  foods  are  as  high  in  jiroteid, 
in  proportion  to  total  food  value,  as  most  uiits  and 
cereals.  Un  the  other  hand,  dried  fruits,  whii-h  are 
sometimes  mentioned  as  containing  a  higher  percentage 
of  proteid  than  other  fruits,  are  as  a  matter  of  fact 
ofter  much  lower.  Thus,  dates  contain  but  2  per  cent., 
prunes  and  raisins  3  per  cent.,  figs  5  per  cent. 


(>.  Ii  should  bo  stilted,  however,  that  all  (\stimates  of  i)roteid 
ari'.  strictly  speaking,  "protein,"  i.  e..  tjV^  times  the  contained  nitro- 
gen. In  some  cases  proteid  and  protein  are  not  identical,  but  the 
former  is  less  than  the  latter,  owing  to  the  fact  that  some  of  the 
nitrogen  is  not  in  i)roteid.  but  in  a  waste  or  useless  form.  This  is 
true  of  almost  all  the  proteid  of  meat  soup*,  which  have,  therefore, 
practically  no  food  value  except  a  ijeptogenic  fiin'.  As  to  vegetables, 
in  default  of  <'xa<'t  data,  no  cDrrcctinn  t'loin  iirntcln  id  i)roteid  is 
here  .attempted. 


It  "is  evident  that  in  most  cases  foods  of  the  same 
class  show  a  famih'  resemblance.  Meats  and  other  flesh 
foods,  with  the  exception  of  shellfish,  are  represented  bv 
points  on  FP,  he'ing  devoid  of  carbohydrates.  Cereals 
are  represented  l)y  points  near  the  carbohydrate  corner, 
C;  nuts,  with  the  exception  of  chestnuts,  are  located 
near  the  fat  corner.  F ;  fruits,  with  the  exception  of 
olives,  near  the  carbohydrate  corner,  C ;  veoerables  show 
a  laroe  rano-p  within  the  trianole.  In  Fioure  8  the 
range  of  each  of  these  classes  is  approximately  shown. 

The  foods  eaten  at  a  meal  may  thus  be  indicated  l)y 
points  on  the  "food  map."'  Opposite  each  point  should 
l)e  written   the   amount   eaten,   measured   in   "standard 


100 
90 

80 
70 

€0 
50 
40 

30 

5 

\ 

\ 

\ 

• 

\ 

\ 

\ 

\ 

20 

\ 

\ 

t'- 

\ 

\ 

^       10     20    30    40     50    60    .70     80    90    100 

Fignrc   11 

]30itions.""  This  array  of  points  presents  a  picture  of 
what  foods  and  how  much  of  each  have  been  eaten,  and 
shows  at  a  glance  their  characteristics.  But  to  use  this 
properly  we  need  to  coml^ine  these  points  into  one  point, 
their  center  of  gravity,  \\hich  represents  the  entire  meal. 
Thi<  may  l)e  done  in  various  ways. 

DEMOXSTRATTXG    C'OMBIXATIOXS 

The  combination  of  two  foods  equal  in  calories  is  rep- 
resented by  a  point  midway  between  them.  Thus,  to 
combine  one  "portion""  of  bread  and  one  "portion"  of 
l)utter  (Fig.  9)  draw  a  straight  line  between  their 
points,  and  at  the  middle  of  it  mark  a  cross  and  label  it 
"2  :"  this  point  will  represent  two  "portions""  of  bread 
and  butter. 


13 


It'  tlio  calorics  of  the  two  foo(]s  arc  iiiUM|ual.  tlic  point 
represent iiiii'  tlu'  coiiiljination  will  Ix-  pi'opoilioiiatcly 
nearci'  the  point  with  llu'  lar,i;'cr  nuniltcr.  Thus,  if  one 
jjortion  of  hreacl  is  eoint)ine(l  with  one-half  portion  of 
l)uttei',  the  hread-and-hutter  ]toint  will  not  he  midway 
hctwecn  the  points  I'oi-  hread  and  for  hutti'r.  hut  will  lie 
twice  as  near  the  hi-cad  point  as' ihc  i)utlcr  point.  Its 
aj)pro\iniate  ]iosition  may  he  found  with  lireat  i-apidity 
hv  the  eve  witliout  makino-  exa^t  measurements. 


Fiuure   1  li 


When  three  foods  are  coml)ined.  the  point  re])resent- 
in.ii  the  comhination  is,  in  like  manner,  the  ''center  of 
gravity"  of  the  three,  and  may  he  found  Ijy  first  ohtain- 
ing  the  center  of  gravity  of  two,  and  then  ohtaining  the 
center  of  gravity  of  the  point  thus  ohtained,  and  the 
third.  Thus  if,  as  in  Figure  !<•.  we  have  three  points 
representing,  lespectively.  3.  I  and  o  calories  of  three 
separate  foods,  shown  hy  the  aitmlicd  nuuihers  3,  4  and 
5,  the  point  representing  the  comhination  may  he  found 
hy  joining  the  points  laheled  3  and  4.  and  finding  their 
center  of  gravity,   7,  situated   nearer  the  point  4  than 


14 


point  3,  and  dividing  the  line  between  them  in  the  ratio 
of  3  to  4.  The  first  two  points,  3  and  4,  may  be  consid- 
ered as  concentrated  at  7  with  their  combined  weight,  7. 
We  then  find  the  center  of  gravity  of  this  new  point  7 
and  the  remaining  point,  5.  ■  The  center  of  gravity  of 
this  point  7  and  point  5  will  be  a  point,  12,  on  the 
straight  line  between  them,  situated  nearer  the  7  than 
the  5,  and  dividing  the  distance  between  in  the  ratio  of 
5  to  7.  At  point  12  the  whole  combination  of  12  por- 
tions may  be  considered  to  be  concentrated.  It  is  evi- 
dent that  we  could  find  the  center  of  gravity  of  the  same 
three  points  by  combining  them  in  a  different  order,  but 
the  result  would  be  the  same. 


Figure  13 

It  is  also  evident  that  more  than  three  points  may  be 
combined  on  the  same  principles  by  combining  them  by 
twos  and  threes  and  then  combining  the  coml)inations. 

When  all  the  points  are  combined  into  one  point,  that 
point  will  represent  the  entire  meal.  If  the  final  point 
thus  found  is  labeled  "22,"  and  is  located  20  per  cent, 
up  and  30  per  cent,  to  the  right,  this  shows  that  in  all 
twenty-two  "portions"  (2,200  calories)  have  been  con- 
sumed, of  which  20  per  cent.  (440  calories)  are  juoteid. 
30  per  cent.  (660  calories)  are  fat,  and  the  l)alance.  50 
per  cent.    (1,100  calories),  are  carbohydrate. 

The  ration  here  exemplified  contains  too  much  pro- 
teid.     If  we  accept  Professor  Chittenden's^  results  as  to 


7.   See    his    "Plivsiological    Economy    in    Nutrition. 
(Stolics),    1904. 


New    York 


15 


]irntci(l  i-L'(iiiiieiiu'nts.  a  \vt'll-l>iiliiiic('(l  daily  latioii  foi- 
tlu'  avi'vajio  ])c'rs<)ii  will  he  i-i'pi-csciilcd  l»y  a  piMiit  lyiiiL;' 
within  the  "normal  i(X'tan«ilo,"  as  shown  in  I'iuurc  11. 
'\'h\<  shows  that  jn'oteid  shonM  he  near  10  ])er  cent. 

All  fcods  niav  ho  classihod  aecordin<;  to  thoir  location 
rehitivoly  to  this  rwtaimlc  Tluis,  all  foods  located 
above  tiie  lectaitulc  ■aw  hiLih-jU'dteid  t'oi)ds;  all  helow, 
low-pioteid  foods;  all  within,  iini'iiial-piotcid  foods. 
Lo(>kini:-  at  the  "food  niaiT"  we  see  aiiion*^'  Ihe  hiiih-pro- 
teid    foods,   heiiinninu'   with   the   lowest,    irrahani   hrcad. 


Figure   14 


macaroni,  tomatoes,  whole-wheat  hi'ead.  pine  nuts, 
beans.  l)ntterniilk,  cheese  and  meats.  Among  the  low- 
proteid  foods.  ])eginninu-  wit1i  the  highest,  are  most 
fruits  (except  laspherries  and  stra wherries),  cieam, 
pecans,  olives,  butter,  olive  oil,  sugar.  Among  the  foods 
normal  in  proteid  are  most  breads,  wheat  flakes,  corn 
flakes,  strawberries,  raspberries,  chestnuts  and  most 
other  nuts  (except  pine  nuts  and  pe<'ans).  In  the  same 
way  we  may  classify  foods  as  to  their  richness  in  fat  or 
carbohvdrate;  but  there  is  a  larger  range  allowable  for 


16 


these  elements  than  for  proteid.  High-proteid  foods 
tend  to  make  the  ration  high  in  proteid,  and  will  do  so 
unless  balanced  by  ]ow-])roteid  foods.  Most  ])ersonp 
consume  nuuh  more  proteid  than  that  in  the  Chitten- 
den standard.  This  excess  may  l:)e  avoided  either  Ijy 
omitting  foods  high  in  proteid  or  Ijy  using  them  very 
sparingly. 

Since  the  resultant  point,  representing  the  ration,  is 
the  center  of  gravity  of  the  points  representing  its  con- 
stituents,   it    is    evident    that    it    can    be    obtained    by 


Figure   15 


mechanical  as  well  as  hy  geoiuetrical  methods.  For  this 
purpose  a  meclianical  diet  indicator  has  been  devised,  as 
shown  in  Figures  12,  13,  14,  15. 

The  essential  feature  of  this  apparatus  is  a  card  on 
which  is  drawn  the  right-angled  triangle  with  which  we 
have  already  become  familiar.  Points  on  this  card  may 
be  located  to  represent  the  various  foods  emploved. 
These  points  may  be  easily  found  from  tables  given  at 
the  end  of  this  article.  Points  representing  the  most 
common  foods  may  be  already  jjrinted  on  it.  At  iwints 
representing   foods   eaten,    pins    with   heavy   heads    are 


ir 

tlu'ust  thruu^h  llu'  (aidhoiird  (  Ki,ii'.  T-i).  tlic  wciiilit  of 
viu-h  n'jin'-i'iitiiiL;-  (^m-  'Vtiuidard  jiDrtioii."  Similar  pins. 
I»ut  DiU'-liair  and  (Ui('-(iuart('r  as  licavv.  arc  alsn  pi'ovidcd 
to  roj)iesont  liall'  and  (juaiicr  ""iiortions.'"  \\  Iumi  these 
])ins  are  placed,  the  total  ration  wliicli  lias  \)vr\\  con- 
sunied  is  easily  found,  simply  hy  counting  the  "por- 
tions"" thus  represented.  For  instam-e.  ii'  tliere  ari'  lo 
|)ins  re|)reseiitin,ii'  ''standard  portions"  and  Id  pins  rep- 
resenting half  "portions"  (and,  therefore,  five  full  "por- 
tions"), the  total  ration  is  20  '"portions,""  or  •^.i»(»() 
calories.  In  ordci'  to  [ind  the  percentages  of  pi'oteid. 
fat  and  earhohydrate  in  this  ration,  it  is  oidy  necessary 
to  ohtain  the  center  of  gravity  of  all  the  pins.  For  this 
jiurpose  the  card  is  placed  in  a  hasket  (Fig.  115)  and 
suspended  on  a  standard  (Fig.  11)  so  that  the  center  of 
gravity  of  the  pins  may  assume  a  ]K)sition  vertically 
under  the  ])oint  of  support.  The  position  of  this  center 
of  gravity  is  easily  indicated  on  the  card  hy  means  of  a 
vertical  pi'icker  (F'ig.  1-")).  whirh  may  he  piTs>('(l  on  the 
card.  Thus,  almost  instantaneously,  the  center  of  grav- 
ity is  found.  The  total  time  consumed  in  placing  the 
]Mns.  adjusting  the  card  and  hasket.  and  finding  the 
center  of  gravity,  is  fouml  to  he,  foi-  accuiate  woi'k. 
ahout  five  minutes.'' 

The  mechanism  in  which  the  cardhoard  triangle  is 
held  is  so  arranged  that  when  the  cardhoard  is  hori- 
zontal the  center  of  gravity  falls  at  a  point  indicating 
normal  food  pro]wrtions.  If  the  center  of  gravity  is  at 
some  other  ]ioint.  the  cardhoard  will  tip,  showing  that 
till-  ration  is  not  "halanced."  If  the  proteid  vertex  tips 
down,  it  indicates  an  excess  of  proteid;  if  the  fat  ver- 
tex, excess  of  fat;  if  the  carljohydrate  vertex,  excess  of 
carl)ohydrate. 

It  is  now  evident  that,  hy  means  of  the  mechanism 
and  the  rectangles  marked  on  the  card,  it  is  a  simple 
matter  to  discover  whether  a  particular  diet  conforms  to 
any  given  standard.  It  is  equally  simple  to  correct  dis- 
crejiancies  thus  found,  and.  if  need  he,  the  corrections 
may  be  made  in  advance  and  the  balanced  ration  pre- 

8.  The  weisrtit  of  tlio  cardboard  and  tho  basljet  containing  it  is 
oliminatcd  liy  the  construction  of  tlic  I)asliet.  Its  center  of  gi-avity 
(wtien  containing  tlie  cardboard  irithoiit  pins)  exactly  coincides 
witli  tlie  point  of  supi)ort.  Ilente.  when  the  baslcet  witli  the  card 
(but  irilhoiit  pins)  is  placed  on  the  point  of  siii)|)ort.  it  tends 
neither  to  swing  (which  wocld  imply  stable  e(|(iililirinm) ,  nor  to 
be  top-heavy  (which  would  inipl.\  unstable  eiiuijilirium  > .  but  is  in 
"neutral"  e(iuilibriuiii.  and  will  ri'main  at  any  angb'  at  whicli  il  is 
plac<'d. 


18 

scribed.  A  trial  ration  may  ])e  ]uit  on  the  card,  and  if 
it  fails  to  balance,  the  pins  may  be  rearranged  and  bal- 
anced with  far  greater  rapidity  than  the  corresponding 
operations  conld  be  carried  out  by  arithmetical  compu- 
tations. 

One  advantage,  however,  of  the  foregoing  methods  is 
that,  whether  the  object  is  merely  to  record  what  is 
consumed  or  actually  to  prescribe,  the  patient  need  not 
be  annoyed  by  having  scales  at  table.  All  weighing 
mav  be  ■  done  in  the  kitchen  and  the  food  served  in 
"standard  portions"  or  in  known  multiples  or  fractions 
of  such  portions.  It  is  only  necessary  that  the  patient", 
or  some  one  else,  shall  report  exactly  what  part  of  the 
various  portions  served  has  been  consumed.  The  patient 
need  not  -even  know  the  food  values  of  the  portions 
served  to  him,  and  thus  the  introspection  and  trepida- 
tion, which  often  defeat  the  very  aim  of  diet  prescrip- 
tion for  the  sick,  may  be  avoided.  For  well  persons  who 
desire  to  keep  a  record  of  their  dietary,  the  method  here 
given .  has  the  advantage  that  when  it  is  once  made 
familiar  it  can  be  employed  without  any  apparatus.  One 
soon  becomes  able  to  recognize  the  quantities  of  the 
ordinary  foods  which  contain  100  calories,  and  to  hold 
in  memory  the  position  on  the  triangle  where  these  foods 
are  indicated.  A  little  reflection  will  then  enable  him  to 
judge  how  many  "standard  portions"  he  has  consumed 
at  a  meal,  and  also  whether  their  center  of  gravity  falls 
within  the  normal  rectangle.  If  he  has  a  good  locative 
imagination,  he  can  rely  entirely  on  his  ment-al  image 
of  'the  triangle.  Any  one  who  has  once  pictured  the 
foods  on  the  "food  map"  is  not  likely  to  forget  their 
several  locations.  He  will  know  that  a  meal  in  which 
soup,  fish,  meat,  certain  high-proteid  vegetables,  eggs, 
cheese,  milk  and  ice  cream  predominate,  must  be  too 
high  in  proteid ;  for  all  these  foods  are  located  above  the 
"normal  rectangle."  Moreover,  he  will  be  able,  after  a 
little  practice,  to  estimate  roughly  the  calorific  value  of 
his  food.  A  "portion"  of  100  calories  may  be  ascribed 
to  each  lamb  chop,  or  its  equivalent  in  other  meat,  each 
(large)  egg,  each  two-thirds  of  a  glass  of  milk,  each 
ordinary  potato,  large  slice  of  bread,  large  banana,  ordi- 
nary pat  or  square  of  butter,  shredded  wheat  biscuit  or 
its  equivalent  in  other  cereal,  eight  almonds,  half  dozen 
English  walnuts,  one  and  one-half  lumps  of  sugar,  etc. 


■oZs 
s  a 


TOO 


a  £■■3  -^  5  •  _  e 


D  Zi  Cs  2^5  =  -, 


is:?: 


liiliiil?? 


jgSS 


io  o  o  o  g  o 


-  o  o  o 


TTT;  T  =!■=. 


S  r-o  o-o 


Si- 


£■3  = 

ctt  ;; 


.5--^.'S.|S  I 

£.°-S,i--- 


-  S5:  5:-: 


53 


SSSa 


?3  = 


9    g 


^^0^-?-g><OCOHHCC[:>;^Hr:  pOOZ:v.wc 


i'-.a; 


2  =  :  ?-S:  ;  2:  : 


iSS    SSSSS3£ 


ssisisi^issSsSss^sSilaiiS 


iSSg^sSSgS^:: 


ggSg^^^i^^iSi'^ 


—  tn      tn      «s  ta  IP  ~1 -J -J -J  _ -J  ■-■  to 
Ora-.tO       »-4&  U  •»■  a  M  93  U  M  S 


-juE~icviv^---3ooutui>Et»ocu£ii> 


;^g2g£;:iSKgS^e^£(r 


£gSffiS^S£SS223::5;3d;JSgSg^S3w2S^ 


sssssssyss^ssss^sssssssgs 


•^  1  w  w  M  o  ?:  ?;  H 
52  =  =  =  =  5'15 


III 


is 


?    ^■^<^'t-~r--^-.  :i- 


I52S-  :  ;=.33?3fa  5-=  =  -"_?■- 


q:   «?^ 


■;i;  %\ 


?-5.; 


3:5"r~:s'^^i?'7:^>  '£-'j»    '^■'vZO^'£XT- 


^-:-3-3"3t-:'rTT3-3i;rt:'T^" 


Si-??'^!?~T7T--2'^"r-'^  "£;,-"*"-"-->>> 


0;?2.2.eS 


DBS   Sig 


^  -3         3  -■  1^  t   -:;     * 

■      ^-■'£r2.^5,^P     S    i*3S  =  %.. 


5  -  2  ^    ^ 


a      v. 


K 


B  -5  3 


^^■av 


rt3'3  c'tf  err  tf : 
:  =  S-a  =  =  /;». 

'-z.'£  a=.c.^  c; 


■  2^*     O 


c-s; 


>  T  «  ■ 

'  O  :  :  : 

H  :  :  : 

w  :  :  : 
75 


s: ; ;  is 


ills 


E? ;  fi 


^  2,3 :  s 

iS-n.:    " 


llfi 


=  H 

- 

-/.-•  — 

H 

cc  CHr r> 

:  23, 

< 
: 

1^^ 

:  =  = 

^2J2Z.^: 

■     K 

^1! 

:  .'' 

iillifsSs 


5i    S«!8SS3SSE8S«SSaS5;3S8S 


sssK  csisafiss       i3sassass!s^s-S3agK:issB       gg 


3SSSS=S5k 


'i'i'f/z"'z—^-S''-e-i.''-£yii 


3^''c'°-''.^s.*a8ag 


SSSSSiSESSiSSSSS 


S!ES18£S8S-iia28S8iPii 


'tSS    21-,  s'.g^g'^ 


3:!!S£2'££S£.iSS:3£gS££3i£$£;«S£SsSf 


11) 

To  illiist  I'atc  till'  iiictlidil  li\    jirMct  ic;il  cxiiiiiiilcs.  let  u-: 
suppose  that  I'or  a  paiticular  patient   the  prcscripl  ion   is 
I'or  '^.01)0  calories  a  day  ot    foods  so  conihini'd   that   tlio 
food  proportions  will  lie  icpreseiited  liy  a  point  within 
the  ritjht  hall'  of  the  roetannle.     To  earrv  out  this  pre- 
scription the  ])atient  looks  at  the  '"t'ood  map  "  and  linds 
no   foods  on   it  wliieli   themselves   fall   within   the   ]ire- 
seribod  area.     He  observes,  liowcver,  that  bread  and  but- 
ter are  located  on  opjiosite  sides  of  this  area,  and  his  eye 
shows  liim  that  a  combination  of  the  two  in  equal  ])arts 
(by  calories,  not  by  weight)  will  very  nearly  fall  within 
it.  though  slightly  too  low.     Corn  flakes  and  cream  eom- 
l)ine  within  the  set  limits;  milk  and  dates    (a    fnxorite 
oriental  combination)  fall  near  the  mark;  poached  eggs 
on  toast   (with  the  whites  left  out)  will  also  come  near 
the  proper  spot,  though   slightly   loo  high;  any  cereal 
foods  or  fruits   (which  lie  at  the  left),  combined  with 
foods  which  lie  at  the  right,  as  egs:  yolk,  nuts  or  cream, 
butter,  olives  or  olive  oil  will  combine  nearly  right,  pro- 
vided the  right-hand  foods  predominate.     Choosing  such 
of  these  combinations  as  are  most  relished,  the  patient 
eats  his  meal.     Afterward   he.  his-  physician  or  nurse, 
indicates    on   the  triangle    l)y   iiencil    marks   each    food 
which  has  been  eaten,  or.  if  he  has  a  mechanical  diet 
indicator,  by  the  weighted  pins.     The-  center  of  gravity 
will  then  show  exactly  where  his  meal  is  located  on  the 
"food  map,-''  and  the  total  nuinber  of  "portions""  "will 
show  how  much  he  has  eaten.   The  cause  of  any  deviation 
from  the  prescription  will  be  very  apparent.    It  may  be 
that  the  point  is  too  high,  indicating  excessive  proteid. 
and  this  may  be  due  to  too  much  milk,  eggs  or  meat ;  or 
too  much  cereal  food  may  have  displaced  the  point  to 
the  left.    These  errors  may  be  rectified  at  the  next  meal. 
At  the  end  of  the  day.  from_  the  cards  used  in  the  three 
meals,  he  selects  the  three  centers  of  gravity  and  trans- 
fers them  to  a  fourth  card,  from  which,  in  the  same 
way,  the  total   calories   and   center  of  gravity  for  the 
three  are  found  ;  this  represents  the  total  day's  ration. 
Or,    again,    a    patient    may    at    first   be    given    carte 
blanche  in   his   food,   merely   reporting  the   "portions" 
eaten.     Each  dish  being  served  in  "portions,"  this  will 
require  little  trouble.     In  fact,  a  nurse  may  do  it  all  by 
noting  what  is  put  on  a  tray  and  wluit  is  left  after  the 
meal.     On  the  basis   of   the  returns,  the   physician   or 
imrse  can  tell  exactly  how  mu-.h  and  what  proportions 


20 

tlie  patient  is  eating,  and  his  besetting  dietetic  sins  Avill 
be  evident.  Tlie  ]:»]iysic'ian  will  be  enabled  thereby  to 
guide  him  intelligently,  suggesting,  for  instance,  that 
he  reduce  his  ration  to  two-thirds  of  what  he  has  been 
accustomed  to.  or  reduce  meat,  eggs,  etc.,  or  take  more 
cream  and  l)utter.  etc.  It  goes  without  saying  that  any 
change  in  diet,  unless  it  be  a  change  in  amount  only, 
should  be  gradual."  Thus,  if  a  person  has  been  accus- 
tomed to  excessive  proteid,  his  stomach  has  probably 
become  adjusted  to  this  condition  and  secretes  a  large 
amount  of  gastric  juice.  AVhen  the  reduction  of  proteid 
is  sudden,  the  gastric  juice  will  not  at  first  decrease  in 
proportion,  and  a  large  part  of  this  secretion  will  there- 
fore remain  unused.  This  uncombined  acid  interferes 
with  the  digestion  of  starch  and  the  person  feels  a  "sour 
stomach."  A  gradual  reduction  of  proteid,  on  the  other 
hand.  Avill  avoid  .this  difficulty.  The  reduction  may  be 
more  rapid  (for  the  hyperacid)  if  the  proportion  of  fat 
is  increased,  as  fat  tends  to  restrain  the  gastric  secre- 
tion. 

In  the  winter  of  3  900  the  mechanical  diet  indicator 
was  employed  for  five  months  in  an  experiment  with 
nine  Yale  students.  Xo  diet  \Aas  prescribed,  and  the 
indicator  was  used  only  to  record  the  diet  which  the 
men  themselves  chose.  It  was  found  that  by  follow- 
ing Mr.  Fletcher's  rules  of  thorough  mastication  and 
obedience  to  appetite,  the  men  gradually  and  natuially 
reduced  their  proteid.  •  The  extraordinary  efFects  on 
their  working  power  are  described  elsewhere.^"  To  what 
extent  such  "natural  eating''  can  help  in  ])athologic 
cases  has  not  yet  been  shown,  although  some  ])hysicians 
are  reported  to  have  found  it  a  very  valuable  aid  in  their 
practice.  Certainly  it  could  scarcely  fail  to  lie  more 
serviceable  than  the  unintelligent  and  reckless  diet  ])re- 
scriptions  so  often  made. 

AY.hether  or  not  diet  prescriptions  are  given,  the 
actual  diet  employed  by  patients  should  receive  study. 
Tills  study  is  made  easy  by  means  of  the  grayihic  and 
mechanical    methods.^^      These    methods   may   be    used 

9.   Hutchison.    Robort  :    Oonoi-al    ronsidorations    on    the    Thera- 
peutic I'ses  of  Diet.  I'ractitionei'.   April.   190(!.   p.   470. 

10.  For  a  short  abstract  see  Science,  Xov.  Iti.  lOOfi.  A  full 
report  will  appear  in  the  Transactions  of  the  Connecticut  Academj- 
of  Arts  and  Sciences. 

11.  There  is  no  patent  on  this  device:  anyone  is  free  to  make  and 
use  it.  The  Battle  Creek  Sanitarium  has  had  experience  in  con- 
structing the  apparatus.  .\  rej^ular  instrument  maker  may  take  up 
its   manufacture   later   if  conditions   warrant. 


21 

witli  advantage  in  ilio  kitrlion  by  lionscwivos  desirons 
of  snjijilyinc:  balanced  meals,  and  may  be  of  special  serv- 
ice in  in?titiiti(ms  wbere  it  is  ini]iortnnt  to  provide  coni- 
])lete  and  \vell-])ro])()rtioned  nourislnnent  at  a  niinimnni 
of  cost.  On  the  meclianieal  diet  indicator  llic  weiirlitcil 
pins  may  be  placed  to  indicate  any  proposed  iiica!.  nnd 
tbis  meal,  by  a  slifjht  adjnstment  of  tlie  weiglits,  may  bo 
balanced  as  exactly  as  desired. 

The  accompanying  table  of  foods  is  classified  under 
several  heads : 

Cookod  meats.  Uncooked  meats. 

Vegetables.  Dairy  products. 

Fruits.  Nuts. 

Sweets  and  pickles.  Cereals. 

Cakes,  pastry,  nuddinss  and  desserts. 
Miscellaneous. 

APPENDIX 

The  preceding  table  gives  the  data  for  the  ordinary  foods,  in 
a  form  most  readily  used  for  the  grapliic  or  the  meclianieal 
metliod.  Tlie  figures  for  carbohydrate  are  included,  although, 
as  has  been  shown,  they  do  not  need  to  be  used  in  practical 
application,  the  location  of  each  food  on  the  "food  map"  being 
completely  determined  by  its  "latitude"  and  "longitiule,"  i.  e., 
the  proportion  of  the  fuel  value  in  proteid  and  fat  respectively. 
The  foods,  so  far  as  possible,  are  prepared  foods  such  as  are 
served  on  the  table,  but  unfortunately,  the  main  sources  of 
information  being  Bulletin  Xo.  2S  of  the  Department  of  Agri- 
culture, for  food  materials,  it  has  not  been  possible  to  include 
all  prepared  dishes  desired.  Moreover,  recipes  vary  so  tliat  it 
would  be  impracticable  to  supply  data  for  such  dishes  wliieh 
could  be  used  with  advantage  or  certainty.  It  is  easily  pos- 
sible, however,  for  any  one  who  uses  the  table  to  add  to  it  the 
necessary  data  for  any  made  dish  of  known  recipe.  All  that  is 
necessary  is  to  translate  the  weights  of  the  various  ingredients 
into  a  number  of  "standard  portions,"  and  then  to  locate  these 
ingredients  on  the  "food  map"  and  find  their  center  of  gravity. 
This  will  indicate  the  position  of  the  composite  food.  The 
weight  of  a  "standard  portion"  of  this  food  is  found  by  divid- 
ing the  aggregate  weight  of  all  the  ingredients  used  by  the 
number  of  "portions"  in  them,  as  above  ascertained. 

Tlius,  to  locate  sponge  cake,  when  the  recipe  is  3  eggs,  1 
"cup"  (4  oz.)  sugar,  and  1  "cup"  (4  oz.)  flour;  the  eggs,  if 
of  ordinary  size,  weigh  4^/4  oz.  and  constitute,  as  the  table 
shows,  2  "portions";  the  sugar,  weighing  4  oz.,  constitutes 
4.65  "portions"  and  the  flour,  weighing  4  oz.,  4.2  "portions." 
This  gives  a  total  weight  of  12 14  oz.,  and  11  as  the  total  num- 
ber of  "portions."  Dividing  the  former  by  the  latter,  we  have 
1.1  oz.  as  the  weight  of  a  "portion"  of  sponge  cake.  The 
position   on   tlie   "fdcxl   map"  of  sponge  cake   is  now  found  by 


32 

putting  the  pins  at  the  points  on  the  map  as  indicated  by  the 
table  for  sugar,  eggs  and  flour.  These  weights,  representing 
respectively  4.65,  2,  and  4.2  "portions,"  the  center  of  gravity 
shows  the  position  of  sponge  cake,  which  is  about  11  per  cent, 
of  proteid  and  about  12  per  cent,  of  fat.  This  result  does  not 
agree  exactly  with  sponge  cake  as  given  in  the  table,  owing  to 
the  difference  in  recipe,  that  in  the  table  probably  including 
shortening. 

Unless  great  precision  is  required,  a  suffi<'ient  approximation 
may  be  obtained  in  general  by  omitting  fractional  portions : 
thus,  we  may  call  the  egg  2  "portions,"  the  sugar  5,  and  the 
flour  4.  The  resulting  center  of  gravity  may  be  found  roughly 
by  the  eye,  without  even  the  aid  of  the  diet  indicator.  It  is 
surprising  how  close  such  a  rough  approximation  will  usually 
be  found  to  the  true  value,  as  tlie  influence  of  the  errors  in  the 
particular  ingredients,  on  the  combined  result,  is  small,  and 
the  various  errors  usually  tend  to  offset  each  other. 

(Should  the  reader  desire  to  add  other  items  to  the  table, 
either  of  food  materials  or  foodstuffs,  he  may  do  so  by  using 
the  sources  from  which  the  table  is  constructed.  Thus,  if  he 
will  obtain  from  the  Department  of  Agriculture  Bulletin  No. 
28,  "Chemical  Composition  of  American  Food  Materials,"  he 
may  translate  the  figures  there  given  into  the  form  to  be 
entered  in  the  table  as  follows :  The  weight  in  ounces  of  a 
"standard  portion"  is  found  by  dividing  1,600  by  the  number 
of  calories  per  pound  given  in  the  table.  The  calories  per  cent, 
of  proteid  is  found  by  multiplying  the  figure  in  the  Bulletin 
table  giving  the  weight  per  cent,  of  proteid,  by  1,860  and 
dividing  the  result  by  the  figure  giving  the  number  of  calories 
per  pound.  The  same  calculation  and  the  same  factor,  1,860, 
apply  to  carbohydrate.  For  fat  tlie  same  calculation  applies, 
but  with  the  substitution  of  the  factor  4,220  in  place  of  1,860. 
The  three  results  may  be  verified  by  adding  the  resulting  fig- 
ures for  proteid,  fat  and  carbohydrate,  the  sum  of  which  should 
be  100  per  cent.  To  weigh  foods,  letter  scales  will  usually 
suffice,  the  food  being  weighed  in  dishes  and  the  weight  of  tlie 
dishes  subtracted. 


Not    to   be    released   until 
September   20,   1910 

INSURANCE  COMPANIES  AND  THE  PUBLIC  HEALTH 

AN  ADDRESS  BY 

PROF.  IRVING  FISHER 

I 

Of  Yale  University,  New  Haven,  Conn. 

Read  Before  the  Twenty-third  Convention  of 

The  International  Association 
Accident    Underwriters 

5RETT0N  WOODS,  N.  H.,  SEPTEMBER  20,  21,  22  &  23,  1910 


Insurance  Companies  and  the  Public  Health. 

In  the  history  of  all  forms  of  insurance  Ave  iind  that  at  first 
i  conception  of  insurance  is  restricted  to  the  one  function  of  trad- 
T  in  risks,  i.  e.,  selling  for  a  price  (called  the  premium)  the  chance 
receiving  an  indemnity  (called  the  insurance).  Later  a  second 
iction  is  almost  invariahly  added,  that  of  reducing  the  risks.  Such 
the  natural  and  inevitahle  order  of  development.  At  first  we 
ist  take  the  risks  just  as  we  find  them.  But  sooner  or  later  we 
cover  that  risks  are  more  or  less  i)reventa})le  and  sooner  or  later 
befalls  that  those  insurance  companies  prosper  most  which  prac- 
3  prevention  as  well  as  indemnification.  The  addition  of  the  pre- 
iting  function  at  first  aroused  antagonism  as  all  new  ideas  do. 
it  it  is  bound  to  win  wherever  prevention  is  found  to  ])ay--which 
probably  everywhere  that  insurance  applies.  First  one  far-sighted 
npany  sees  profits  in  prevention  and  then  competition  compels 
liers  to  follow  its  example  or  withdraw  entirely  from  the  race. 

It  would  seem  that  marine  insurance  has  stimulated  to  safe 
p  construction  as  much  as  any  one  factor  in  the  history  of  ship- 
Iding. 

In  the  history  of  fire  insurance,  the  mutual  companies  first 
de  the  effort  to  reduce  fire  risks.  When  the  importance  of  ex- 
ising  the  function  of  preventing  fires,  as  well  as  indemnifying 
linst  fires,  once  entered  into  the  plans  of  stock  companies,  they 
n  overtook,  if  they  did  not  outrun,  the  mutual  companies.  It  is 
imated  that  the  risk  from  fire  in  certain  particular  classes  has  been 
uced,  through  the  fire  insurance  companies,  some  seventy  ])er 
t.  In  New  England  seventy  years  ago  the  rate  on  cotton  and 
3len  mills  averaged  three  or  four  dollars  per  himdred.  Today 
se  mills  are  being  insured  at  a  total  cost  per  annum  of  seven 
ts  per  hundred.  In  some  cases  the  cost  has  been  reduced  to  1-100 
the  former  amount.  This  enormous  decrease  has  been  accom- 
{hed  by  slight  expenditures.  In  some  factories  the  cost  of  im- 
•vements  has  been  more  than  paid  for  in  the  saving  of  ])remiums 
fire  insurance  in  one  year.  The  stock  companies  were  forced  by 
comj)etition  of  the  mutual  com])anies  to  take  up  ])reventive 
isures.     They  now  employ   fire  insurance  engineers  to  maintain 


I 

i 


laboratory  in  Cliica<>'o  wliich  is  well  equipped  for  the  purpose  of 
tudying  fire-resisting  materials,  fire-resistinL>-  deviees,  and  new  a])- 
aratus  and  fire  prevention  in  general.  Many  fire  insurance  men 
elieve  that  this  laboratory  is  their  best  investment.  No  reduction 
1  rate  is  guaranteed  until  fire  figliting  devices  are  a|)])roved  by  the 
iboratory. 

I  understand  that  in  steam  boiler  insurance,  under  the  leader- 
lip  of  one  man,  the  companies  assuming  these  risks  gradually  dis- 
jvered  tliat  it  ])aid  to  put  back  nearly  half  of  their  premiums  into 
le  work  of  insj^ection  of  boilers  witii  a  view  of  preventing  ex- 
losions. 

In  emi)loyers'  liability  insurance,  the  idea  of  prevention  has 
lade  great  headway.  Here  the  companies  are  all  stock  companies, 
it  they  have  learned  that  their  function  is  not  simply  to  distribute 
sses,  but  to  lessen  them  as  well. 

The  sanie  idea  of  prevention  doubtless  plays  an  important  i)art 
most  other  forms  of  insurance,  such  as  live  stock  insurance,  cyclone 
isurance,  burglary  insurance,  plate  glass  insiu'ance,  fidelity  in- 
irance. 

Finally  the  movement  toward  ])revention  is  now  taking  pos- 
!Ssion  of  Hiose  forms  of  insiu'ance  most  vitally  connected  with 
liman  life, — accident  insurance,  health  insurance  and  life  in- 
;  ranee. 

n 

On  February  5th,  1909,  I  had  the  honor  of  addressing  the  As- 

ciation  of  Life   Insurance  Presidents  in  New  York  Citv  on  the 

conomic  Aspect  of  I^engthening  Human  Life.     As  a  member  of 

resident   Roosevelt's   Conservation   Commission    I   had   just   com- 

eted  a  report  on  our  National  Vitality,  Its  Wastes  and  Conserva- 

)n,  and  as  President  of  the  Committee  of  One  Hundred  on  Na- 

t)nal  Health   I   was  then,   as   I   am  now,   actively  engaged  in  an 

)rt  to  secure  a  National  De})artment  or  Bureau  of  Health.     In 

\    address   I   suggested  that  the   life   insurance   companies   could, 

i)titably  to  themselves,  and  especially  to  the  country,  co-operate 

the  health  movement  now  spreading  over  the  whole  world.     The 

association  appointed  a  Committee  on  Human  Life  Extension,  of 

lich  ^Ir.  Ide,  President  of  the  Home  Life,  is  chairman.    This  com- 

;ttee  has  held  several  meetings  in  New  York  and  AVashington. 

It  is  a  profound  satisfaction  to  have  had  even  a  minor  part  in 
augurating  the  movement  to  introduce  prevention  into  life  in- 
rance,  for  I  am  fully  persuaded  tluit,  sooner  or  later,  life,  accident 


and  liealtli  insurance  companies  will  assume  their  rightful  place  i 
among  the  most  ])owerful  engines  for  human  safety,  health  and  ; 
l()iij>cvitv  the  world  has  ever  seen. 

But,  tliough  many  have  mistakenly  thought  and  said  so,  I  can-  \ 
not  lay  claim  to  heing  the  first  to  suggest  the  particij)ation  of  life  j 
insurance  companies  in  the  health  movement.  Mr.  Iliram  J.  Mes-  j 
^enger,  actuary  of  the  Travelers'  Insurance  Company,  Dr.  Burn- ' 
side  Foster,  Prof.  .J.  Pease  Norton,  and  I  helieve  many  others,  had  : 
reached  the  same  idea  independently.  The  industrial  department  ; 
3f  the  ^Metropolitan  Life  Insurance  Company,  under  the  guidance  ! 
Df  ]NIr.  Lee  K.  Frankel,  had  already  laid  ])lans  to  reduce  its  mortality,  i 

xVt  present  the  movement  has  only  just  begun;  although  it  has,  | 
[  believe,  gone  far  enough  to  demonstrate  its  wisdom.    The  Metro-  ' 
)olitan  has  established  a  consumptive  sanatorium  for  its  employees 
n  the  face  of  much  opposition  and  in  spite  of  an  adverse  decision  at  | 
irst  by  the  Insurance  Commissioners  of  New^  York  State  as  to  their  | 
•ight  to  do  so;  it  has  engaged  visiting  nurses  to  co-operate  w^ith  visit-  1 
ng  nurses'   associations  in  certain  cities  to  care  for  its   bed-ridden  ' 
policyholders;   it  has  established   a  health    magazine    to    distribute 
lealth  literature  among  its  policyholders, — v/hich  magazine  is  made 
.vailable  to  15,000,000  readers,  or  one-sixth  of  the  population  in  the  ' 
Jnited  States;  and  it  has  endorsed  in  several  wavs  and  on  several  ! 
■ccasions  the  movement  for  a  National  Department  of  Health.  ! 

The  Provident  Life  Assurance  Company  has  established  a  health  > 
•ureau  which  performs  two  functions,  one  of  issuing  bulletins  of  ! 
ealth  information  among  its  policyholders,  the  other,  of  granting  : 
3  those  who  choose,  free  medical  examinations.  At  first  these  free  i 
xaminations  were  to  occur  everv  two  years,  but  the  results  were  im-  ' 
lediately  found  to  be  so  satisfactory  in  holding  off  the  Grim  \ 
leaper,  who  was  creeping  upon  his  victims  unawares,  that  the  in- 
n'val  for  periodical  examinations  has  been  reduced  to  one  year. 

I  The  New  York  Life  Insurance  Company  has  taken  a  hand  in 
le  effort  to  improve  and  purify  the  milk  supply  of  New  York  City. 
]Mr.  Robert  L.  Cox,  counsel  for  the  Association  of  Life  Insur- 
ace  Presidents,  states  that  "practically  all  of  the  companies  repre- 
tmted  in  the  Association  of  Life  Insurance  Presidents  are  o-ivins* 
leir  moral  support  to  the  movement  for  the  prolongation  of  human 
fe.  In  addition,  many  of  them  are  doing  practical  educative  work, 
feasured  by  number  of  ]:K)licies  in  force,  the  Association  companies 
)ver  78  per  cent,  of  the  field  of  American  companies,  having  21,- 


700,000  policies  out  of  a  total  of  about  28,000,000.  The  Associa- 
tion coni})anie.s  cnoagiufr  in  individual  work  alon<j'  health  betterment 
lines  have  T-J  per  cent,  ol'  tlie  total  number  of  pobcies  in  force,  or 
20,.)()0.()00;' 

'There  is  another  group  of  e()m])anies  in  the  iVssoeiation  which 
goes  beyond  the  body  of  policyholders  in  its  health  promotion 
activities.  They  advise  impaired  applicants  for  insurance  as  to  their 
physical  condition  and  make  suggestions  to  aid  them.  There  are 
four  com])anies  in  this  group.  Two  of  them,  in  the  Kast,  have  a 
total  of  80,000  policies.  Another  is  a  flourishing  ^Middle  West  com- 
pany that  has  about  150,000  policies.  The  fourth  is  a  young  and 
conservative  Southern  company  with  7,200  ])olicies." 

"One  of  the  Connecticut  companies  has  published  suggestions  as 
to  health  reform  in  its  magazines  to  agents.  Two  other  comjjanies 
— one  of  jNIassachusetts  and  the  other  of  California— are  consider- 
ing active  work  in  the  future." 

i  The  fraternal  societies  have  entered  the  campaign.  Their 
sjournal,  the  Western  Review,  now  has  a  department  especially  de- 
i^^oted  to  the  public  health.  Fraternal  insurance  companies  have  also 
in  several  instances  established  sanatoria,  and  have  attempted  in  other 
ivays  to  lengthen  lives  and  decrease  death  claims. 
I  The  accident  companies  have,  I  understand,  for  some  time,  aided 
n  getting  State  laws  passed  to  prevent  accidents  to  life  and  limb. 

Finally,  health  insurance,  one  of  the  yoimgest  forms  of  insur- 
ince,  has  made  a  beginning  in  the  field  of  prevention.  The  Loyal 
'rotective  Insurance  Company  has,  within  the  last  few  months,  es- 
ablished  a  health  bureau  to  issue  bulletins  and  conduct  a  sort  of 
orrespondence  school  of  health  information.  Considering  the  fact 
hat  few,  if  any,  of  the  existing  insurance  companies  have  been  en- 
*aged  in  health  insurance  for  more  than  fourteen  years,  their  pres- 
nt  entrance  into  the  field  of  prevention  is  unusually  prompt.  Per- 
Dnallv  I  believe  that  in  health  and  accident  insiu'ance, — and  es- 
ecially  in  health  insurance — there  are  gigantic  possibilities  of  profit, 
use  the  term  profit  rather  than  philanthroj)y  in  recognition  of  the 
let  that  insurance  companies  as  such  have  no  business  to  undertake 
hilanthropic  w^ork  except  when  it  is  profitable.  In  the  end  the 
loney  gains  made  by  the  insurance  companies  by  reducing  mortality 
id  invalidity  will  be  shared  by  the  public  in  reduced  premiums. 

5 


My  object  in  this  paper  is  two-fold,  (1)  to  show  that  the  un- 
exploited  possibihties  of  improved  safety  and  health  constitute  a 
veritable  bonanza  for  insurance  companies,  and  (2)  to  show  sonu 
ways  in  which  the  insurance  companies  may  begin  in  the  work  of  ex- 
ploiting- this  bonanza. 

First,  then,  What  room  for  im})rovement  is  there  in  the  matter 
of  American  accidents  and  ill  health?  For  answer  I  beg  to  refer  you 
to  mv  report  on  National  VitaHtv  to  President  Roosevelt  on  behalf 
of  his  National  Conservation  Commission.  Such  reference  will  save|| 
you  the  trouble  of  listening  to  an  elaborate  statistical  argument.  In 
the  re])ort  referred  to  it  is  shown  that  human  life  in  America  could,] 
by  the  adoj)tion  of  hygienic  reforms  already  known  and  entirely 
practicable,  be  lengthened  over  one-third — that  is,  over  fifteen  years. 
This  calculation  has  been  made  very  conservatively  and  is  j^robably 
several  years  inside  the  truth.  The  statistics  and  estiniates  on  which 
it  is  based  have  been  taken  from  published  sources,  as  well  as  con- 
tributed by  some  score  of  American  authorities — medical,  actuarial 
and  hvgienic.  It  is  estimated  that  at  least  eio-ht  years  could  be  added 
to  human  life  merely  by  securing  reasonably  pure  air,  water  and 
milk. 

Now  it  is  well  known  that  mortality  and  invalidity  are  very  in- 
timately related.  Farr  attempted  to  establish  a  ratio  betw^een  them. 
He  calculated  that  for  every  death  each  year  there  Avas  an  average  of 
two  persons  sick  throughout  the  year.  But  whether  or  not  we  can 
establish  a  fixed  ratio  betw^een  deaths  and  invalidity  no  one  wull  gain- 
say that  they  are  sufficiently  connected  to  enable  us  to  reason  from 
one  to  the  other.  In  the  absence  of  good  invalidity  statistics,  mor- 
tality may  therefore  be  accepted  as  a  rough  barometer  of  invalidity; 
and  longevity  as  a  rough  barometer  of  vitality  and  health.  We  may 
therefore  conclude  that  the  possibility  of  adding  fifteen  years  to  hu- 
man life  carnes  with  it  the  possibility  of  adding  greatly  to  human 
health.  If  the  ratio  of  disease  to  death  be  a  fixed  one,  such  exten- 
sion of  human  life  would  reduce  invalidity  in  the  same  ratio  as  it 
would  reduce  mortality, — which  would  be,  ultimately,  about  25  per 
cent. 

There  is  reason  to  suspect  that  the  reduction  in  invalidity  would 
be  even  more  than  the  reduction  in  mortality.  This  may  be  reason- 
ably  inferred  from  one's  general  study  of  the  prevention  of  disease 
and  in  particular  from  the  fact  that  mortality  is  only  preventable  up 
to  a  certain  point — for  every  one  must  die  some  time — whereas  dis- 
ease may  perhaps  in  the  millennium  be  abolished  entireh\    Pasteur 


said:  "It  is  within  the  power  of  man  to  rid  himself  of  every  parasiti 
disease."  And  if  in  the  (hstant  future  disease  shall  be  so  much  mor 
preventable  than  deatli,  it  is  ])robab]y  more  ])reventable  at  ever 
stage  of  progress.  AVe  feel  reasonably  safe,  tlierefore,  in  statin, 
that  every  success  attending'  our  efforts  to  reduce  mortality  will  b 
attended  by  at  least  equal  success  in  reducing  invalidity. 

We  now  know  that  the  death  rate  is  not  the  fixed  and  fatalisti 
thing  it  was  once  su])posed  to  be,  but  that  on  the  contrary  it  varie 
according  to  many  known  conditions. 

The  estimates  of  Finkelburg  show  that  in  Europe  human  lif 
has  doubled  in  the  last  350  years.    More  recent  and  more  reliable  fig 
ures  show  tliat   life  is  lengthening  today  more  rapidly  than  ever 
If  we  take  life  tables  for  different  periods  for  EfUgland,   France 
Prussia,  Denmark,  Sweden,  and  ^Massachusetts,  w^e  find  that  humai 
life  lengthened  during  the  seventeenth  and  eighteenth  centuries  a 
the   rate   of   four   years   per   century;   that   during   the   first   three 
quarters  of  the  nineteenth  century  it  lengthened  at  the  rate  of  abou1 
nine  years  per  century;  that  at  present  it  is  lengthening  in  Europt 
generally  at  the  rate  of  17  years  per  century,  and  in  Prussia  (which  i; 
perhaps  the  home  of  preventive  medicine)    at  the  rate  of  27  year;- 
per  century.    For  this  country  the  rate  can  only  be  judged  froiT 
the  statistics  for  JNIassachusetts,  which  show  that  life  is  lengtheninc 
by  about  fourteen  years  per  century,  or  approximately  half  of  tht 
Prussian  rate.     These  rates  may  not  continue  in  the  future,  but  the 
opinion  of  our  best  authorities  on  longevity,  such  as  Ray  Lankastei 
and  INIetchnikoff,  is  that  there  is  still  great  room  for  imj^rovement, 
especially  after  middle  life.    Hitherto  almost   all  the  improvement 
has  been  applied  to  ages  before  fifty  and  only  the  most  recent  fig-|i 
ures  show^  any  tendency  toward  improvement  beyond  that  age. 

Recent  figures  for  England  show  improved  mortality  at  every 
age  of  life,  and  in  a  September  magazine  Mr.  Lee  Frankel  tells  us 
that  recent  statistics  for  the  JNIetropolitan  Life  Insurance  Conqiany, 
covering  forty-eight  million  years  at  risk  and  over  three-quar- 
ters of  a  million  death  claims,  show  the  following  improvement:  The 
death  rate  of  policyholders  20  years  of  age  declined  in  eleven  years 
from  10.5  per  thousand  to  7.6;  that  of  ])()licyholders  80  years  old  from 
15.7  to  11.8;  of  those  40  years  old  from  19.3  to  14.9.  These  and  other 
statistics  and  facts  remove  entirely  the  old  objection  that  improved 
mortality  is  only  to  be  expected  of  infants  or  of  those  below  the  ages 
of  policyholders.    This  improvement  is  ascribed  by  Dr.  Frankel  to 


1 


( 


a 


the  general  movement  throughout  the  United  States  during  the  last 
decade  for  hetter  tenements,  milk,  water,  etc. 

It  is  significant  that  backward  India — in  spite  of  the  enormous 
room  for  improvement — shows  during  twenty  years  no  rate  of  im- 
provement whatever.  Ijife  there  remains  only  half  the  Km'opean 
span.     This  is  because  hygiene  is  so  little  practiced. 

A  fall  of  the  death  rate  always  promptly  follows  sanitation. 
Colonel  Gorgas  cut  the  death  rate  in  Havana  in  two,  bringing  it 
down  to  between  20  and  24  per  1,000.  The  New  York  death  rate 
responded  at  once  to  Colonel  Waring's  clean  streets.  And  recently 
it  is  announced  that  the  death  rate  of  New  York  is  16.5,  the  lowest 
)n  record — a  result,  in  all  human  probability,  due  to  the  hygienic  work 
if  the  health  officer,  the  milk  reformers  and  the  public  agitation  for 
lealth. 

Contrast  the  death  rates  from  yellow  fever  at  Panama  during 
■.he  efforts  of  the  French  to  dig  the  canal  and  during  the  American 
vork  under  the  sanitary  regulations  of  Colonel  Gorgas! 

All  evidence  points  clearly  to  the  value  of  preventive  measures 
n  the  conflict  with  disease.  The  fall  in  tuberculosis  mortality  is  di- 
rectly due  to  the  growing  use  of  hospitals,  which  have  tended  to  iso- 
ate  consumptives,  and  to  a  use  of  outdoor  life;  typhoid  fever  has 
irtually  disappeared  when  water  and  milk  supplies  have  been  made 
mre,  the  open  privy  abolished,  and  flies  and  other  carriers  of  the 
pecific  cause  of  the  disease  have  been  provided  against ;  smallpox  has 
fiven  a^\ay  before  vaccination ;  yellow  fever  is  fast  disappearing  now 
hat  the  agent  of  transmission  is  known;  while  many  of  the  less 
erious  diseases  are  losing  their  power,  purely  owing  to  preventive 
leasures. 

As  to  the  preventability  of  accidents  in  the  United  States,  it  is 
nly  necessary  to  contrast  their  frequency  here  and  in  Europe.  The 
ailroad  accidents  in  this  country  are  not  only  more  numerous  than 
1  Europe  but  many  times  more  numerous,  the  exact  ratio  depend- 
ig  on  the  country  and  on  the  method  of  measuring. 

The  Commissioner  of  Labor  of  INIinnesota  has  stated  that  in  his 
pinion  at  least  half  of  all  industrial  accidents  are  preventable. 
>ther  authorities  have  ex])ressed  similar  opinions.  There  is  now 
^ery  reason  to  hope  that,  with  the  recent  establishment  of  a  bureau 
P  mines,  the  accidents  in  mining  will  within  a  few  years  show  a  sub- 
antial  decrease. 

8 


!S 


t 


In  my  report  of  Xational  Vitality  I  have  collected  the  estimates 
)f  a  large  number  of  authorities  as  to  the  degree  of  preventability 
)f  00  causes  of  death. 

On  the  basis  of  these  figures,  tlie  total  imnibcr  of  needless,  or 
•ather  premature,  deaths  in  the  United  States  is  estimated  at 
130,000. 

If  we  accept  Farr's  conclusion  that  corresponding  to  each  death 
here  was  an  average  sickness  of  two  years,  there  are  probably  con- 
tantly  ill  in  the  United  States  about  3,000,000  persons,  of  whom 
00,000  are  consum.ptives.  The  best  authorities  agree  that  at  least 
alf  this  illness  is  needless.  We  have,  then,  abundant  evidence  that 
here  is  a  vast  amount  of  unapplied  scientific  knowledge  capable, 
dien  applied,  of  greatly  reducing  the  mimber  of  victims  of  disease 
nd  death.  This  knowledge  has  come  suddenly,  most  of  it  within  a 
eneration,  since  the  epoch-making  work  of  Pasteur,  IJster,  Koch, 
''on  Behring,  ]Metchnikoff,  Chittenden  and  many  others.  The  mod- 
rn  laboratory  is  manufacturing  knowledge  faster  than  it  is  being 
pplied.  jNIoreover,  the  rate  of  increase  in  hygienic  knowledge  will 
oubtless  increase  rather  than  decrease  in  the  future.  This  is  the 
tuation  of  which  insurance  companies  can  now  take  advantage. 

Since  life  and  health  insurance  companies  have  to  deal  with  dis- 
bility  and  deaths  as  questions  of  dollars  and  cents,  I  may  add  a  few 
ords  as  to  the  financial  side  of  the  question. 

Dr.  Farr  has  estimated  the  net  economic  value  of  an  English 
^ricultural  laborer  at  various  times  of  life  by  discounting  his  chance 
'  future  earnings  after  subtracting  the  cost  of  maintenance.  On  the 
isis  of  tables  in  my  report  on  National  Vitality,  it  is  estimated  that 
le  average  value  of  the  lives  now  sacrificed  by  preventable  deaths  is 
;  least  $1,700.  Since  the  number  of  preventable  deaths  is  estimated 
;  630,000,  the  annual  waste  from  preventable  deaths  is  630,000  times 
1,700,  or  about  $1,000,000,000.  This  represents  the  annual  pre- 
;ntable  loss  of  potential  earnings. 

We  saw  that  there  are  always  3,000,000,000  persons  in  the 
nited  States  on  the  sick  list,  of  whom  about  1,000,000  are  in  the 
Drking  period  of  life  and  about  three-quarters  are  actually  workers 
id  must  lose  at  least  $700,  which  makes  the  aggregate  loss  from 
ness  more  than  $500,000,000.  Adding  to  this  another  $500,000,- 
»0  as  the  expense  of  medicines,  medical  attendance,  special  foods, 
2.,  we  find  the  total  cost  of  illness  to  be  about  $1,000,000,000  per 
ar,  of  which  it  is  assumed  that  at  least  one-half  is  preventable.  Add- 


iiig  the  preventable  loss  from  death,  }j>l,00(),()0(),()()(),  to  tlie  preventable 
loss  from  illness,  $5(){),()()(),()0(),  we  find  one  and  a  half  billions  as  the 
very  lowest  at  which  we  can  estimate  the  preventable  loss  from  dis- 
ease and  death  in  this  country.   The  true  fio'ures  may  well  amount  to 

a.  C*  • 

several  times  this  fi<>ure,  but  when  statistics  are  l)ased  ])artially  on 
2()n  jecture,  they  need  to  be  stated  with  especial  caution. 

The  cost  of  conservation  is  often  trifiiniJ'  in  com])arison  with 
the  saving  attained.  For  instance,  the  hook-worm  disease  in  the  South 
impairs  the  earning  power  of  its  workmen  by  25  or  .30  per  cent.  To 
restore  this  earning  power  costs,  by  curing  this  disease,  on  an  aver- 
ige,  less  than  $1  for  each  case.  Other  examples  show  that  the  return 
Du  investments  in  health  are  often  several  thousand  per  cent,  per 
mnum.  Probably  no  such  unexj^loited  opportunity  for  rich  returns 
exists  in  any  other  field  of  investment.  Mr.  Messenger,  the  actuary, 
mggests  that  if  insurance  companies  should  combine  to  contribute 
^200,000  a  year  for  the  purpose  of  improving  the  ])ublic  health,  the 
lost  would  be  one-eighth  of  1  per  cent,  of  the  premiums,  and  it  would 
)e  reasonable  to  expect  a  decrease  in  death  claims  of  nuich  more  tluui 
1  per  cent.  Even  this  1  per  cent,  would  make  a  j^rofit  of  more  than 
leven  times  the  expense. 

Actuaries'  tables  show  that  a  reduction  of  one-third  in  mortality 
'vould  enable  the  premium  to  be  reduced  by  over  fifteen  per  cent. 

Dr.  Frankel,  in  the    article    already    referred    to,    states    that 

jihrough  the  lessening  in  mortality  which  has  already  been  going  on 

jvithout  special  effort  on  the  part  of  insurance  companies,  the  policy- 

liolders  of  his  com])any  have  received  back  from  the  com])any  over 

Imd  above  their  policy  contracts  the  tidy  sum  of  $23,00(),0()0.    Cer- 

ainly  it  stands  to  reason  that  intelligent  and  esjDccially  concerted 

iction  by  insurance  com])anies  should  bear  fruit  worth  many  times 

he  cost.     In  the  case  of  health  insin*ance  the  saving  would  be  still 

p-eater  for  the  reason  that  the  rate  of  interest  does  not  enter  as  so  dis- 

urbing  a  factor.    The  insurance  men  whom  I  have  consulted  as  to 

vhether  it  would  pay  to  engage   in  the  saving  of  lives  have  been 

jinaniuKmsly  affirmative  in  their  answers. 

The  c(mclusion  seems  safe  that  here  is  a  rich  unex])loited  field 
or  saving  money.  And  the  beauty  of  it  is  that  these  gains  bring  with 
hem  gains  far  more  precious  to  the  nation  than  dollars — immeasur- 
ible  gains  of  longevity,  vitality,  efficiency,  and  hap])ines«.  Jjife, 
jiealth  and  accident  insurance  is  not  ])hilanthropy  but  it  is  a  beneficent 
jiusiness.  Though  at  first  glance  it  might  seem  that  to  prevent  the 
►ollution  of  streams,  to  improve  the  milk  su])ply,  to  obtain  pure  foods, 
.nd  freedom  from  accident  is  no  part  of  tlie  business  of  :ns\n'ance,  yet 

11) 


it  is  oasv  enoiinli  to  sec  the  vei'v  vital  fonnectioii.  I5\  I'jir  I  he  larger 
part  of  the  cost  of  the  insurance  business  is  not  uianagcinent  Jior 
agent's  fees,  but  the  cost  of  niortabty  and  invahdity.  It  is  the  right, 
if  in  fact,  it  is  not  the  dutv,  of  any  l)usiness  to  reduce  its  cost.  To  -jare 
iown  sahiries  might  not  save  the  policvhohler  one  per  cent,  of  his 
preniiiiin.  I)ut  to  reduce  inortah'ty  cost  might  save  him  many  i)er  ^'cnt. 

W'liat,  tiien,  can  accident  and  healtli  insui-ance  com))anies  do  to- 
ward the  reduction  of  accidents  and  illness :*  They  can  follow  the 
example  of  the  xMetro])olitan,  the  New  York  Life,  the  Provident  J.ife, 
the  Loyal,  and  other  C!)mj)ames,  which  have  already  blazed  the  way, 
md  they  can  set  their  experts  to  study  the  ])rol)lem  with  reference 
;o  devising  still  other  methods.  Their  work  of  prevention  like  that  of 
ire  ])revention  can  l)e  classified  under  two  lieads,  — the  \^'ork  rf  pre- 
tention among  their  own  policyholders  in  ])articular  and  the  coorpera- 
;i()n  with  public  health  agencies  toward  ])revention  i!i  general.  '■'Mre 
[nsurance  Companies  not  only  compel  or  induce  their  policyholders 
:o  take  certain  precautions  against  tire,  but  they  act  on  the  co)nmunity 
is  a  whole  and  stimulate  it  to  provide  a  pro})er  fire  department,  proper 
niilding  laws,  etc.  In  the  same  way  the  life  insurance  com])an!es  are 
low  advocating  that  the  Government  take  up  the  organization  and 
!o-ordination  of  public  health  service. 

By  arousing  the  Government  of  the  United  States,  of  the  .States 
md  of  municipalities  to  greater  activity,  the  insurance  companies 
rvould  reap  a  large  share  of  the  benefit  without  incurring  all  tiie  cost, 
[n  other  words,  the  insured  lives  would  not  have  Lo  carrv  the  entire 
cad.  but  could  induce  the  taxpayer  to  do  his  share. 

To  ])e  specific,  the  Insurance  Companies  may  act  '\u  the  following 
vays : 

1st.  By  examination  and  correspondence  they  may  give  specific 
nformation  or  advice  to  individual  policyholders. 

2nd.  They  may  diffuse  existing  knowledge  of  hygiene — es])eci- 
illy  of  personal  hygiene — among  their  policyholders. 

.-Jrd.  Bv  investigation,  thev  mav  discover  the  ultimate  conditions 
'or  optimum  vitality  and  safety.  AVith  'the  exce])tion  of  the  investi- 
gations of  ^Nletchnikoff,  very  little  scientific  work  is  now  being  done  as 
o  the  factors  of  longevity. 

4th.  By  resolutions  and  by  personal  representation,  they  may  aid 
n  the  passage  of  laws  and  regulations  for  ])ublic  liealth  and  safety, 
n  city,  state  and  nation,  and  in  general  cooperate  with  and  give  stim- 
ilus  to  all  existing  agencies  for  im])roving  human  vitality. 

11 


Were  tlicrc  time.  I  slioiild  like  to  l>()  into  (i(  lails  in  rct'creiice  t;) 
each  of  these  four  sijo-oestions.  1  will,  however,  confine  myself  to 
three  s})ecitic  sugo-estions  to  this  association  as  an  association.  The 
first  is  that  it  a])i)oint  a  committee  consisting  of  those  fittest  to  con- 
struct a  woi'kahle  and  detailed  scheme  for  the  use  of  the  companies 
constitntin<>-  the  association.  The  second  is  that  the  association  shall 
by  resolution  put  itself  on  record  as  fuv()rinf>'  the  establishment  of  a 
National  Department  of  Health:  and  third  that  it  authorize  the  aj)- 
pointment  of  one  or  more  re])resentatives  to  attend  tlie  future  Con- 
oressional  hearings  on  Public  Health  bills. 

This  is  a  commercial  country  and  Congress  is  influenced  by  the 
wishes  and  argunients  of  commercial  organizations.  As  an  offset  to 
the  commercial  interest  opposed  to  a  Department  of  Health — the 
food  adulterators  and  ])romoters  of  pro])rietary  medicines— the  sup- 
port of  Life  Accident  and  Health  Insurance  Companies  has 
been  and  will  be  a  strong  influence. 

President  Taft  and  Ex-President  Roosevelt  have  favored  a  Bu- 
reau of  Health  and  both  have  reaffirmed  this  advocacy  within  a  month. 
The  medical  profession,  the  Public  Health  Association,  and  associa- 
tions of  State  and  Territorial  Boards  of  Health,  scientific,  ])hilan- 
thropic,  labor,  and  grange  organizations,  and  the  recent  Conservation 
Congress  have  advocated  the  project.  It  is  one  of  the  burning  ques- 
tions of  the  day  and  made  especiall}^  so  by  the  opposition  from  the 
quacks  and  the  quack  interests.  I  trust  that  this  association  will  join 
with  other  insiu'ance  organizations  in  the  effort  to  secure  a  Depart- 
ment of  Health  worthv  of  the  Xation. 


12 


Obe^^eTExknsionlfnstilute 

BY 

PROF.  IRVING  FISHER 

of  Yale  University 


xMARCH  9,  1914 


M 


.i-: 


THE  LIFE  EXTENSION  INSTITUTE 

BY 

PROF.  IRVING  FISHER 

of  Yale  University,  (delivered  at  tke  Annual  Banquet 
of  trie  Insurance  Institute  of  Hartford,  Conn. 

MARCH  9.  1914 


THE  LIFE  EXTENSION  INSTITUTE 

II Y 

PROF.  IRVING  FISHER 

of  Yale  University,  delivered  at  the  Annunl  Banquet 

MARCH  9.  1914 


In  the  history  of  insurance  we  find  that  at  first  the  concep- 
tion of  insurance  is  restricted  to  the  function  of  tradin^^  in  risks, 
i.  e.,  selHng  for  a  price  (called  the  premium)  the  chance  of 
receivinfi^  an  indemnity  (called  the  insurance).  Later  a  second 
function  is  almost  invariably  added,  that  of  reducing  the  risks. 
Such  is  the  natural  and  inevitable  order  of  development. 

The  plan  of  reducing  risks  through  prevention  has  for  many 
years  been  followed  by  the  various  types  of  insurance  companies 
such  as  marine,  fire,  steam-boiler,  cyclone,  burglary,  plate-glass, 
accident,  etc.  When  applied  to  life  insurance  companies  the 
reduction  of  risks  by  prevention  means  the  prevention  of  disease 
and  death  among  polic}^  holders.  The  problem  for  life  insurance 
companies  was  therefore  (1)  whether  life  could  be  prolonged; 
(2)  whether  its  prolongation  would  cost  the  insurance  companies 
less  than  it  would  return. 

As  to  the  first  problem,  it  was  once  believed  that  human 
mortality  followed  an  inexorable  law.  We  now  know,  however, 
that  the  death  rate  is  not  the  fixed  and  fatalistic  thing  it  was 
once  supposed  to  be,  but  that  on  the  contrary  it  varies  according 
to  many  known  conditions.  The  estimates  of  Finkelburg  show 
that  in  Europe  human  life  has  doubled  in  the  last  350  years. 
More  recent  and  more  reliable  figures  show  that  life  is  lengthen- 
ing today  more  rapidly  than  ever.  If  we  take  life  tables  for 
different  periods  for  England  and  France,  Prussia,  Denmark, 
Sweden,  and  Massachusetts,  we  find  that  human  life  lengthened 
during  the  seventeenth  and  eighteenth  centuries  at  the  rate  of 
four  years  per  century;  that  during  the  first  three-quarters 
of  the  nineteenth  century  it  lengthened  at  the  rate  of  about  nine 
years  per  century;  that  at  present  it  is  lengthening  in  Europe 
generally  at  the  rate  of  seventeen  years  per  century  and  in  Prussia 
(which  is  perhaps  the  home  of  preventive  medicine)  at  the  rate 
of  twenty-seven  years  per  century.  For  this  country  the  rate  can 
only  be  judged  from  the  statistics  for  Massachusetts,  which  show 
that  life  is  lengthening  by  about  fourteen  years  per  century, 
or  approximately  half  of  the  Prussian  rate. 

There  is  no  reason  why  our  lives  should  not  be  as  long  as 
those  of  our  Swedish  and  Danish  brethern  across  the  sea,  just 
as  there  is  no  need  that  the  length  of  life  in  India  should  be,  as 


it  is,  only  half  that  of  Europe  and  America.  It  may  be  Utopian 
to  expect  that  a  hundred  years  from  now  human  life  in  Germany 
will  actually  be  twenty-seven  years  longer  than  it  is  today,  but 
the  fact  is  that  such  prolongation  will  occur  unless  the  present 
rate  of  progress  be  slackened. 

In  my  report  on  "National  Vitality"  for  the  Conservation 
Commission  I  tried  to  compute  the  effects  on  human  longevity 
of  preventing  each  preventable  disease,  not  on  the  assumption 
of  total  preventability,  but  on  the  assumption  of  partial  prevent- 
ability,  the  degree  being  conservatively  estimated  for  me  by 
the  best  medical  experts  available.  The  prolongation  of  life 
which,  at  the  very  lowest,  is  certainly  attainable,  has  been 
worked  out  from  each  of  ninety  causes  of  death.  The  total  was 
found  to  be  about  fifteen  years.  Undoubtedly  this  is  a  low 
minimum.  In  selected  groups  such  as  apply  in  life  insurance 
the  possible  prolongation  would  be  far  greater. 

The  second  problem  of  the  insurance  companies  is  whether 
or  not  the  prolongation  of  human  life  will  mean  a  net  gain.  By 
far  the  larger  part  of  the  cost  of  the  insurance  business  is  not 
management,  nor  agent's  fees,  but  the  cost  of  mortality  and 
invalidity.  It  is  the  right,  if  in  fact,  it  is  not  the  duty,  of  any 
business  to  reduce  its  cost.  To  pare  down  salaries  might  not 
save  the  policy  holder  1%  of  his  premium,  but  to  reduce  mor- 
tality cost  might  save  him  many  per  cent.  A  dollar  saved  from 
reduced  mortality  will  buy  a  policy  holder  as  much  as  a  dollar 
returned  to  him  from  any  other  source.  If  it  is  wise,  just  and 
sound  business  practice  to  spend  money  to  guard  against 
impaired  lives  being  insured,  it  follows  that  it  must  be  wise, 
just  and  sound  business  practice  to  spend  a  reasonable  sum 
annually  to  keep  the  policy  holder  unimpaired  as  long  as  pos- 
sible after  he  is  insured,  and  for  the  very  same  purpose,  namely  — 
to  prevent  a  needlessly  high  mortality  average. 

The  cost  of  life  conservation  where  it  has  been  practiced 
outside  of  life  insurance  is  often  trifling  in  comparison  with  the 
saving  attained.  For  instance,  the  hook-worm  disease  in  the 
South  impairs  the  earning  power  of  its  workmen  by  25%  or  50%. 
To  restore  this  earning  power  costs,  by  curing  this  disease,  on  an 
average,  less  than  $1  for  each  case.  The  investment  of  the  SI 
or  less  is  returned  to  the  worker  about  every  working  day  of  his 
life.  Other  examples  show  that  the  return  on  investments  in 
health  are  often  several  thousand  per  cent,  per  annum.  Probably 
no  such  unexploited  opportunity  for  rich  returns  exists  in  any 
other  field  of  investment. 

The  late  Mr.  Messenger,  suggested  that  if  insurance  com- 
panies should  combine  to  contribute  S200,000  a  year  for  the 
purpose  of  improving  the  pubhc  health  the  cost  would  be  one- 
eighth  of  1%  of  the  premiums,  and  it  would  be  reasonable  to 
expect  a  decrease  in  death  claims  of  much  more  than  1%.    Even 


this  1%  would  make  a  jirofit  of  more  tlian  seven  times  the 
expense. 

In  every  life  insurance  company  there  is  a  group  of  policy 
holders  varying  from  3%  to  5%  of  the  total,  who  will  accept 
free  medical  examinations  annually  and  suggestions  as  to  disease 
prevention,  if  the  company  chooses  to  supply  this  life  saving 
service.  It  is  obvious,  expecially  in  view  of  the  favorable  mental 
attitude  of  these  people,  that  to  bring  them  under  health  exami- 
nations and  suggestions  will  result  in  lowering  the  mortality  rate 
in  that  group. 

Nor  is  it  difficult  to  understand  why  the  cost  of  this  service 
is  readily  recovered  when  we  consider  how  very  few  lives  it  is 
necessary  to  prolong  in  order  to  cover  the  expense  even  in  a 
large  group.  For  instance,  at  a  flat  rate  of  $3.00  each  the  medical 
examination  of  a  group  of  5,000  people  annually  would  cost 
S15,000.  With  the  average  policy  at  $2,000  the  cost  of  this 
service  would  be  saved  in  interest  alone,  if  each  life  were  extended 
an  average  of  eleven  days.  That  this  is  far  within  the  limits  of 
reasonable  probability  is  apparent  when  we  note  that  the  entire 
cost  would  be  thus  covered  by  the  prolongation  of  but  30  lives 
out  of  the  entire  5,000  examined  in  varying  ratios,  e.  g.,  one  Hfe 
being  prolonged  twenty  years ;  two,  fifteen  years;  four,  ten  years; 
six,  five  years; seven,  three  years;  and  ten,  one  year.  This  refers 
to  the  one  item  of  interest.  The  premium  saved  on  these  30  lives 
would  amount  to  more  than  $5,000. 

Bright's  disease  and  other  kidney  affections  alone  cost 
90,000  lives  annually.  At  least  70%  of  these  lives  could  be  saved 
or  prolonged  if  these  insidious  diseases  could  be  detected  in  their 
incipiency.  And  it  is  a  matter  of  common  knowledge  that 
health  examinations  would  readily  detect  their  presence  in  time 
to  arrest  or  cure  them.  Health  examinations  would  prolong 
enough  lives  menaced  by  kidney  diseases  alone  to  pay  the  cost 
several  times  over  of  the  periodical  health  examinations  by 
insurance  companies,  and  the  same  may  be  said  of  heart  disease, 
arterial  degeneration  and  other  chronic  maladies  that  can  be 
detected  in  their  early  stages  by  blood  pressure  tests  and  other 
diagnostic  methods.  In  one  of  the  older  companies  43%  of  the 
deaths  were  due  to  these  diseases  (of  the  heart,  etc.)  and  42% 
of  the  applications  rejected  are  charged  to  evidences  of  these 
same  maladies.  The  same  ratio  doubtless  holds  good  in  all 
excepting  the  younger  companies. 

The  conclusion  seems  safe  that  there  is  a  rich  unexploited 
field  for  saving  money.  And  the  beauty  of  it  is  that  these  gains 
bring  with  them  gains  far  more  precious  to  the  nation  than 
dollars  —  immeasurable  gains  of  longevity,  vitality,  efficiency 
and  happiness.  The  life  insurance  company  that  endeavors 
to  reduce  sickness  and  to  prolong  life  renders  the  very  highest 
form  of  human  service,  and  wins  the  warm  approval  and  support 
of  its  poHcy  holders  and  of  the  pubHc. 


6 

The  life  insurance  companies  have  at  last  begun  to  move  in 
this  direction.  In  a  short  time  the  movement  promises  to  be 
general.  This  will,  I  believe,  mark  one  of  the  greatest  steps,  if 
not  the  greatest  step,  ever  taken  toward  the  improvement  of 
human  longevity. 

As  far  back  as  1905  the  Loyal  League,  a  fraternal  company, 
opened  a  sanatorium  for  policy  holders  who  should  contract 
tuberculosis.  The  Modern  Woodmen  opened  a  similar  sanato- 
rium in  1908.  Other  fraternal  companies  have  done  the  same. 
The  Metropolitan  was  the  first  old  line  insurance  company  to 
enter  this  field  of  welfare  work,  having  established  a  welfare 
department  under  Dr.  Lee  K.  Frankel  in  1909.  In  the  same  year 
the  Provident  Savings,  later  merged  into  the  Postal,  opened  a 
health  bureau.  This  was  the  first  to  undertake  the  work  of 
medical  re-examinations  of  policy  holders,  a  work  which  will 
now  be  continued  for  this  company  as  for  others  by  the  newly- 
formed  Life  Extension  Institute.  The  Metropolitan  established 
a  sanatorium  in  1911,  and  a  District  Nurse  Service  about  the 
same  time.  The  Equitable  has  had  a  conservation  department 
for  four  years  under  a  conservation  commissioner,  Mr.  E.  E. 
Rittenhouse.  The  Association  of  Life  Insurance  Presidents  has, 
since  1909,  had  a  committee  on  health  which  has  sought  in 
particular  to  secure  the  enactment  of  better  state  laws  governing 
vital  statistics. 

The  Life  Extension  Institute  is  specially  organized  and 
equipped  to  supply  an  effective  life-saving  service  to  life  insur- 
ance companies  at  a  cost  much  lower  than  they  could  possibly 
operate  such  a  comprehensive  service  themselves.  Briefly,  this 
service  consists  of  health  examinations  arranged  by  the  Institute 
to  detect  disease  in  its  early  stages,  when  it  can  be  checked  or 
cured,  and  of  an  educational  program  to  increase  physical 
efficiency  by  promoting  healthful  living  and  protection  against 
disease.  It  will  deal  solely  with  prevention.  Treatment  will  be 
left  to  the  family  physician.  The  specific  plan  regarding  life 
insurance  companies  will  be  the  forming  of  contracts  with  such 
companies  to  offer  examinations  to  certain  groups  of  their  policy 
holders  at  regular  intervals. 

The  Directors  of  the  new  Institute  are:  Ex-President  Taft, 
who,  since  his  experience  with  tropical  hygiene  in  the  Philippines 
and  Panama,  has  been  an  enthusiast  on  the  possibilities  of  modern 
scientific  hygiene;  Harold  A.  Ley,  the  originator  of  the  plan; 
Prof.  Irving  Fisher;  Frank  A.  VanderHp,  President  of  the 
National  City  Bank  of  New  York;  E.  R.  L.  Gould,  originator  of 
the  Model  Homes  Association;  Francis  R.  Cooley,  of  Hartford; 
and  Henry  H.  Bowman,  banker,  of  Springfield,  Mass.  Dr. 
Eugene  L.  Fisk,  the  well  known  writer  and  worker  in  hygiene,  is 
Medical  Director.  The  Hygiene  Reference  Board,  which  will 
direct  the  hygienic  policy  of  the  company,  contains  many  emi- 
nent names,  such  as  Colonel  Wm.  C.  Gorgas,  Surgeon  General, 


U.  S.  A.;  Dr.  Rupert  Blue,  Surs^con  General.  U.  S.  P.  II.  S.; 
Dr.  Harvey  W.  Wiley,  Director,  Hureau  of  Foods,  Sanitation 
and  Health,  "Good  Housekeeping  Magazine";  William  J.  Harris, 
Director  of  Census,  Washington;  Dr.  George  Blumer,  Dean, 
Yale  Medical  School;  Dr.  David  L.  Edsall,  Professor,  Clinical 
Surgery,  Western  Reserve  University;  Dr.  J.  H.  Kellogg, 
Superintendent,  Battle  Creek  Sanitarium:  Dr.  Victor  C.  Vaughn, 
President  of  the  American  Medical  Association;  Dr.  Russell  H. 
Chittenden,  Professor  of  Physiological  Chemistry;  Director, 
Sheffield  Scientific  School,  Yale  University;  Dr.  William  H. 
Welch,  Professor  of  Pathology,  Johns  Hopkins  University,  and 
President,  Maryland  State  Board  of  Health;  Miss  Mabel  T. 
Boardman,  Chaimian,  American  Red  Cross  National  Relief 
Board;  Dr.  WicklifTe  Rose,  Director,  Rockefeller  Sanitary 
Commission,  etc.;  Hon.  Walter  H.  Page,  Ambassador  to  Eng- 
land; Dr.  Alexander  Graham  Bell,  of  the  Board  of  Scientific 
Directors,  Eugenics  Record  Office. 

No  single  company  or  group  of  companies  could  secure  for 
this  purpose  the  service  of  such  a  group  of  philanthropic,  busi- 
ness and  scientific  men  as  have  volunteered  to  serve  on  the 
Hygiene  Reference  Board  and  as  Directors  of  the  Institute. 
This  board  is  already  actively  at  work  on  its  literature  and 
policy. 

The  advantage  of  the  Life  Extension  Institute  over  single 
companies  lies  in  the  fact  that  in  serving  a  number  of  companies, 
the  Institute  is  able  to  relieve  each  of  the  burden  of  administra- 
tion and  much  of  the  cost  thereof.  As  an  expert  salaried  stafT  is 
developed  in  the  larger  centers,  it  will  be  possible  to  reduce  the 
cost  of  the  service  and  a  further  reduction  can  be  effected  by  the 
avoidance  of  duplicate  examinations  among  those  insured  with 
a  number  of  companies  having  contracts  with  the  Institute. 
Evidently  it  would  be  a  saving  to  life  insurance  companies  if 
examinations  of  appHcants  had  been  made  through  one  organi- 
zation. It  may  be  too  late  now  to  change  the  present  plan  of 
separate  examinations,  but  this  economy  can  certainly  be 
efTected  with  health  examinations  by  adopting  the  combined 
service  plan  at  the  start.  The  companies  do  not  need  to  fonn  a 
central  bureau.    It  exists  ready  to  their  hand. 

We  have  already  made  contracts  with  a  few  life  insurance 
companies  and  commercial  organizations  to  examine  policy 
holders  and  employees  and  have  approached  some  organizations 
in  Hartford.  It  is  expected  that  several  of  the  Hartford  com- 
panies will  enter  into  contract  with  the  Life  Extension  Institute, 
but  in  most  cases  the  matter  has  not  yet  progressed  to  the  point 
where  a  definite  statement  can  be  made.  The  Connecticut 
General,  however,  has  definitely  promised  a  contract  with  the 
Life  Extension  Institute  to  examine  all  policy  holders  of  over 
five  years'  standing. 


8 

The  Life  Extension  service  of  the  Institute,  beside  that 
offered  to  policy  holders  in  companies  contracting  with  it, 
includes  provision  for  health  examinations  for  individuals 
applying  directly,  for  schools,  for  members  of  clubs  and  similar 
organizations,  for  employees  of  business  enterprises.  That  is, 
the  Institute  stands  ready  to  contract  with  any  individuals,  or 
groups  of  individuals  to  furnish  periodic  examinations,  supple- 
mented by  regular  health  bulletins.  To  put  it  briefly  —  the 
Institute  will  offer  the  general  public  a  practical  life  saving 
service. 

The  Institute  is  primarily  a  philanthropic  organization.  In 
order  that  its  service  to  humanity  may  be  continuous  and  its 
existence  perpetuated  without  the  aid  of  charitable  contributions 
the  Institute  has  been  organized  as  a  self-sustaining  philanthropy. 
The  charges  of  the  Institute  are  put  at  the  lowest  possible  point. 
Two-thirds  of  any  profits  above  a  small  rate  of  interest  will  be 
applied  to  public  use  in  life  extension  work  in  preventive  fields 
that  a  life  insurance  company  itself  cannot  enter.  With  the 
exception  of  the  active  administration  officers  the  gentlemen  on 
the  Board  of  Directors  and  the  Hygiene  Reference  Board  donate 
their  services  to  the  Institute  as  a  contribution  to  human  wel- 
fare. One  special  province  of  the  Institute  will  be  to  study  and 
promote  personal  hygiene  as  distinct  from  public  hygiene.  Today, 
especially  in  America,  personal  hygiene  is  neglected  on  all  sides. 
In  fact,  in  the  United  States,  it  is  nobody's  business.  The  duty 
of  making  a  systematic  and  scientific  study  of  personal  hygiene 
falls  neither  to  government  officers,  private  institutions,  or 
individuals. 

Another  most  important  function  from  the  viewpoint  of 
public  service  which  the  Life  Extension  Institute  will  perform 
is  in  more  promptly  introducing  new  advances  in  hygiene.  It 
will  be  able  to  crystalize  the  best  opinion  in  one  authoritative 
statement  that  will  reach  every  physician  in  the  country  and 
which  every  physician  in  the  country  will  respect  from  the 
character  of  the  men  sending  it  forth. 


5' 


NGRESS I  SENATE 


f  D(kl;.mi:.nt 
^d  Session      f  ox:.i.-.^YXi.  <     j^t^^_.j|,, 


NATIONAL  VITALITY 

ITS  AVASTES  AND  CONSERVATION 


By 
IRVING   FISHER 


Extract  from  Report  of  the  National  Conservaiion  Commission 

(Senate  Document  No.  676,  Vol.  Ill,  Sixtieth 

Congress,  second  session) 


PRESENTED  BY  MR.  OWEN 


March  8,  ISHO. — Ordered  to  be  printed,  with  illustration 

WASHINGTON 

GOVERNMENT  PRINTING   OFFICE 

1910 


NATIONAL  VITALITY,  ITS  WASTES  AND  CONSERVATION. 


By  Ievinq  Fisheb, 
Professor  of  Political  Economy,  Yale  University. 


ACKNOWLEDGMENTS. 

The  materials  upon  which  this  report  is  principally  based  were 
collected  during  the  last  ten  years.  They  are  far  from  complete,  and 
I  had  expected  to  make  use  of  them  at  my  leisure  for  a  series  of 
special  articles,  but  the  opportunity  which  suddenly  presented  itself 
of  utilizing  them  in  the  construction  of  this  report  was  one  which 
could  not  be  resisted,  despite  the  fact  that  the  time  available  was 
only  three  months.  In  the  endeavor  to  make  the  best  use  of  this 
time  I  have  been  compelled  in  some  cases  to  rely  on  secondary 
sources  of  information.  The  number  of  such  cases  has  been  greatly 
reduced,  however,  through  the  kindness  of  colleagues,  friends,  and 
correspondents  who  were  appealed  to  for  suggestions,  criticisms,  and 
supplementary  material.  I  am  greatly  indebted  to  Prof.  Lafayette 
B.  Mendel,  of  the  Sheffield  Scientific  School  of  Yale  University,  for 
helpful  comments  and  detailed  criticism  of  the  whole  report,  and 
especially  of  those  parts  relative  to  the  physiology  of  nutrition;  to 
Prof.  Yandell  Henderson,  for  many  helpful  suggestions;  to  Prof. 
Henry  W.  Farnam,  for  suggestions  regarding  the  topics  of  industrial 
conditions;  to  Prof.  M.  V.  O'Shea,  of  the  University  of  Wisconsin, 
for  carefully  revising  the  major  part  of  the  section  on  school  hygiene; 
to  Dr.  Charles  Wardell  Stiles,  Chief  of  the  Division  of  Zoology, 
Hygienic  Laboratory,  United  States  Public  Health  and  Marine- 
Hospital  Service,  for  information  on  the  extent  and  burden  of  the 
hook-worm  disease;  to  Surg.  Gen.  Robert  M.  O'Reilly,  of  the  United 
States  Army,  for  statistics  of  army  hygiene;  to  Dr.  Prince  A.  Mor- 
row, of  New  York  City,  and  to  Prof.  C.  R.  Henderson,  of  the  Uni- 
versity of  Chicago,  for  carefully  prepared  notes  in  regard  to  "  the 
social  evil." 

I  am  indebted  to  Dr.  Herbert  E.  Smith,  dean  of  the  Yale  Medical 
School,  for  general  criticism;  and  to  his  colleagues.  Profs.  Joseph  M. 
Flint,  George  Blumer,  H.  L.  Swain,  and  Oliver  T.  Osborne,  for 
criticism  and  aid,  both  general  and  special. 

Among  the  many  others  who  have  rendered  very  valuable  assist- 
ance I  would  especially  mention  Dr.  J.  H.  Townsend,  secretary  Con- 
necticut state  board  of  health;  Dr.  Cressy  L.  Wilbur,  Chief  of 
Division  of  Vital  Statistics,  Bureau  of  the  Census;  Col.  W.  C. 
Gorgas,  chief  sanitary  officer.  Isthmian  Canal  Commission ;  Dr.  J.  N. 
Hurty,  secretary  of  the  state  board  of  health  of  Indiana ;  Dr.  Charles 
V.  Chapin,  city  health  officer.  Providence,  R.  I. ;  Dr.  George  H.  Sim 
mons,  of  Chicago,  secretary  of  the  American  Medical  Association;, 
Dr.  J.  N.  McCormack,  lecturer  of  the  American  Medical  Association;] 
Dr.  William  J.  Mayo,  formerly  president  of  the  American  Medical' 
Association;  Dr.  Henry  P.  Walcott,  president  Massachusetts  state 
«20 


I 


riSHEE.]  NATIONAL   VITALITY.  621 

)onrd  of  health;  Prof.  F.  F.  Wesbrook,  dean  of  the  Medical  School 
)f  the  University  of  Minnesota;  Dr.  Henry  B.  Baker,  ex-secretary 
Vlichigan  state  board  of  health;  Dr.  "William  C.  AVoodward,  health 
)fficer  of  the  District  of  Columbia;  Dr.  (ieorge  M.  Kober,  dean  of 
Georgetown  Medical  College;  Dr.  Norman  E.  Ditman,  of  Columbia 
■Jniversity;  Dr.  J.  H.  Kellogg,  superintendent  of  the  Battle  Creek 
Sanitarium,  and  his  assistants,  Dr.  J,  T.  Case  and  Dr.  W.  H.  Riley; 
Dr.  Ixichard  C.  Newton,  of  Montclair,  N.  J.;  Dr.  Luther  H.  Gulick, 
)f  New  York  City;  Dr.  W.  G.  Anderson,  director  Yale  gymnasium; 
3r.  Charles  H.  Castle,  of  Cincinnati,  Ohio;  Dr.  J.  P.  C.  Foster,  of 
>Iew  Haven ;  Prof.  Russell  H.  Chittenden,  director  of  the  Sheffield 
Scientific  School  of  Yale  University;  Leo  F.  Rettger,  assistant  pro- 
cessor of  hygiene,  Yale  University;  Dr.  George  M.  Gould,  of  Ithaca, 
^.  Y. ;  Dr.  Helen  C.  Putnam,  of  Providence,  R.  I.;  F.  B.  Sanborn, 
if  Cambridge,  JNLass. ;  Hiram  J.  Messenger,  actuary  of  the  Travelers 
insurance  Company,  Hartford;  Mrs.  Ellen  H.  Richards,  of  the 
klassachusetts  Institute  of  Technology;  Mrs.  Frank  P.  Kinnicutt,  of 
•^ew  York  City;  and  William  H.  Tolman,  of  the  Museum  of  Safety 
,nd  Sanitation,  New  York  City. 

To  the  help  received  from  these  persons  will  be  due  in  large  measure 
whatever  of  value  this  report  may  have.  I  could  not,  single-handed, 
lave  done  justice  to  even  a  portion  of  the  subject.  Except  for  a  few 
tatistical  monographs  and  papers  cited  in  it,  I  have  contributed 
ittle  original  material.  It  has  been  my  task  to  interpret  material 
irought  together  from  many  sources.  Despite  all  the  aid  received,  I 
m  aware  that  the  report  abounds  in  sins  of  omission.  Great  pains 
save  been  taken  to  avoid  those  of  commission.  Doubtful  material 
las  been  eliminated  so  far  as  possible,  and  where  exact  ligures  were 
mobtainable,  every  eifort  has  been  made  to  see  that  the  statements 
aade  should  be  cautious  and  conservative. 

For  aid  in  the  difficult  work  of  incorporating  into  the  manuscript 
he  numerous  suggestions  received,  I  am  indebted  to  Profs.  J.  Pease 
Wton,  William  B.  Bailey,  Fred  R.  Fairchild,  and  Dr.  L.  W.  Zart- 
aan,  of  the  economic  department  of  Yale  University;  and  to  Dr. 
L  M.  Scarborough,  of  the  Yale  Medical  School,  and  Dr.  F.  B. 
jtandish,  of  New  Haven.  For  criticisms  on  the  form  of  presenta- 
ion,  I  am  indebted  to  Mr.  Edwin  Bjorkman,  of  New  York  City; 
0  Mr.  ]\Iichael  Williams,  of  Oak  Bluffs,  Mass. ;  and  to  Mr.  Herbert 
L.  Smith,  of  the  U.  S.  Forest  Service. 

I  wish  to  thank  the  Interstate  Commerce  Commission  and  Prof, 
lenry  C.  Adams,  the  statistician  of  the  commission,  for  temporarily 
'etailing  Mr.  Julius  H.  Parmelee,  a  member  of  the  Statistical  Division 
f  the  Interstate  Commerce  Commission,  to  the  work  of  compiling  the 
laterial  gathered  from  various  sources.  Mr.  Parmelee  has  brought  to 
is  work  an  unusual  equipment.  His  studies  have  been  not  only  in 
tatistics,  but  also  in  hygiene.  Added  to  his  knowledge  he  has  en- 
husiasm  for  the  subjects  covered  and  a  keen  appreciation  of  their 
nportance.  The  aid  which  he  has  rendered  has  been  much  more 
urn  that  of  mere  calculator  and  compiler.  His  ability,  thoughtful- 
ess,  and  self-sacrificing  devotion  have  resulted  in  painstaking  work 
f  a  high  order,  without  which  the  report  could  not  have  been  written 
1  the  allotted  time. 

Irving  Fisher. 
Yale  University,  November,  1908, 


I 


SUGGESTIONS   FOR   READERS. 

In  crder  that  this  report  may  be  read  and  used  as  widely  as  pos< 
sible,  it  has  been  arranged  with  reference  to  five  classes  of  readers: 

1.  The  "  Contents  by  sections,"  the  index,  and  the  page  headingji 
will  facilitate  the  use  of  the  report  for  reference  purposes. 

2.  The  "  Abstract "  is  chiefly  intended  for  those  who  have  no  time 
to  read  more. 

3.  The  "  Summary  "  is  a  somewhat  fuller  resume. 

4.  The  "  Summary"  is  also  designed  to  enable  those  who  so  desin 
to  read  some  parts  of  the  report  more  fully  than  others.  To  this  end 
the  "  Summary  "  is  arranged  to  correspond  to  the  main  report,  chap- 
ter by  chapter  and  section  by  section.  The  reader  who,  after  reading 
any  particular  part  of  the  "  Siunmary,"  wishes  to  read  the  corre-' 
sponding  part  of  the  main  report  has  only  to  turn  to  the  chapter  oi 
section  having  the  same  number.  j 

5.  Those  who  read  the  entire  report  will  probably  prefer  to  read 
the  "Summary"  or  "Abstract"  last. 

t>22 


ABSTKACT. 

The  prolilem  of  conserving  natural  rosonrees  is  only  one  part  of  the  larpor 
proltleui  (if  ('(lusi'rv  iii^:  national  ellicieney.  The  other  jiart  relates  to  the  vitality 
)f  onr  iiopulation.  The  two  jiarts  are  closely  interwoven.  Protection  against 
iilning  aeciilents,  forest  tires.  Hoods,  or  pollution  of  streams  prevents  not  only 
OBS  of  proi)erty,  but  loss  of  life.  The  prevention  of  disease,  on  the  other  hand, 
ncreasos  economic  productivity. 

So  far  as  we  can  compare  vital  and  physical  assets  as  measured  by  earning 
30wer.  the  vital  assets  are  three  to  five  times  the  physical.  The  facts  show 
:hat  there  is  as  great  room  for  imiirovement  in  our  vital  resources  as  in  our 
ands.  waters,  minerals,  and  forests.  This  improvement  is  possible  In  respect 
)Oth  to  the  length  of  life  and  to  freedom  from  disease  during  life. 

Contrary  to  common  impression,  there  is  no  iron  law  of  mortality.  Recent 
statistics  for  India  show  that  the  average  duration  of  life  there  is  less  than 
:wenty-five  years.  In  Sweden  it  is  over  fifty  years,  in  Massachusetts  forty-five 
rears.  The  length  of  life  is  increasing  wherever  sanitary  science  and  prevent- 
ive medicine  are  applied.  In  India  it  is  stationary.  In  Europe  it  has  doubled 
n  three  and  a  half  centuries.  The  rate  of  increase  during  the  seventeenth  and 
jighteenth  centuries  was  about  four  years  per  century,  during  the  first  half  of 
he  nineteenth  century  about  nine  years  per  century,  during  the  latter  half  of 
he  nineteenth  century  about  seventeen  years  per  century,  and  in  Germany, 
vhere  medical  and  sanitary  science  has  reached  the  highest  development,  about 
:weuty-seven  years  per  century.  The  only  comparative  statistics  available  in 
:his  country  are  for  Massachusetts,  w^here  life  is  lengthening  at  the  rate  of 
ibout  fourteen  years  per  century,  or  half  the  rate  in  Germany. 

There  is  no  need,  however,  of  waiting  a  century  for  this  increase.  It  could 
>e  obtained  within  a  generation.  Thx-ee-fourths  of  tuberculosis,  from  which 
50,000  Americans  die  annually,  could  be  avoided.  Eighteen  experts  in  various 
liseasos,  as  well  as  vital  statisticians,  liave  contributed  data  on  the  ratio  of 
)reventability  of  the  ninety  different  causes  of  death  into  which  mortality 
nay  be  classified.  From  these  data  it  is  found  that  fifteen  years  at  least  could 
>e  at  once  added  to  the  average  human  lifetime  by  applying  the  science  of 
)reventing  disease.  More  than  half  of  this  additional  life  would  come  from  the 
)revention  of  tuberculosis,  typhoid,  and  five  other  diseases,  the  prevention  of 
vhich  could  be  accomplished  by  purer  air,  water,  and  milk.  In  Lawrence, 
dass.,  after  the  installation  of  a  pure-water  supply,  the  death  rate  from  typhoid 
vas  reduced  by  80  per  cent.  For  every  death  thus  saved  from  typhoid,  two 
If  three  deaths  are  saved  from  other  diseases. 

Judging  from  the  English  statistics  of  illness,  we  must  conclude  that  at  all 
Imes  in  the  United  States  about  3,000,000  persons  are  seriously  ill,  of  whom 
ibout  500,000  are  consumptives.     Fully  half  of  this  illness  is  preventable. 

If  we  appraise  each  life  lost  at  only  $1,700  and  each  year's  average  earnings 
or  adults  at  only  $700,  the  economic  gain  to  be  obtained  from  preventing  pre- 
'entable  disease,  measured  in  dollars,  exceeds  one  and  a  half  billions.  This 
;ain,  or  the  lengthening  and  strengthening  of  life  which  it  measures,  can  be 
ecured  through  medical  investigation  and  practice,  school  and  factory  hygiene, 
estriction  of  labor  of  women  and  children,  the  education  of  the  public  in  both 
uihlic  and  private  hygiene,  and  through  improving  the  etBciency  of  our  munic- 
l»al,  state,  and  national  health  service.  Our  National  Government  has  now 
everal  bureaus  exercising  health  functions,  which  only  need  to  be  concentrated 
mder  one  department  to  become  coordinated  parts  of  a  greater  health  service 
^Forthy  of  the  nation. 

623 


SUMMARY. 
Summary  of  Part  I. — Lensjtii  of  life  versus  mortality. 

SUMMARY  OF  CHAPTER  1 — THE  LENGTH   OF  LIFE. 

Section  1.  In  different  places. — President  Roosevelt  has  pointed  out  that  th( 
problem  of  conserviug  our  natural  re'sources  is  part  of  another  and  greater  prob 
lem — that  of  national  efficiency.  This  depends  not  only  on  physical  environuieni 
but  on  social  environment,  and  most  of  all  on  human  vitality.  Modern  hygiene 
is  the  reaction  against  the  old  fatalistic  creed  that  deaths  inevitably  occur  at  : 
constant  rate.  The  new  motto  is  that  of  Pasteur:  "It  is  within  the  power  o 
man  to  rid  himself  of  every  parasitic  disease." 

It  was  once  believed  that  human  mortality  followed  an  "  inexorable  law.'. 
Facts,  however,  show  that  mortality  varies  in  different  places  and  is  decreasing 
as  hygiene  comes  into  use.  The  length  of  life  in  Sweden  and  Denmark  is  ove: 
fifty  years;  in  the  United  States  and  England  about  forty-five;  in  India  less  thai 
twenty-five. 

Sec.  2.  At  different  times. — In  Europe,  according  to  one  authority,  the  lengtl 
of  life  has  increased  in  three  hundred  and  fifty  years  from  less  than  twenty  ti 
about  forty  years;  in  England,  in  less  than  half  a  century,  it  has  increased  abou 
five  years';  in  Prussia,  in  the  last  quarter  of  a  century,  over  six  years;  h 
America  it  has  also  increased,  although  good  life  tables  are  lacking  exceptinj 
for  insurance  experience.  The  tables  for  Massachusetts  for  1893-1897  show  ai 
average  duration  of  life  in  that  State  of  forty-five  years,  as  compared  with  fortj 
in  1855,  and  thirty-five,  an  estimate  of  1789,  based,  however,  on  doubtful  returns 

SUMMARY  OF  CHAPTER  II — THE   MORTALITY  RATE. 

Section  1. — Relation  of  longevity  to  mortality.— Ks  duration  of  life  increases 
the  death  rate  decreases.  A  death  rate  is  the  ratio  of  the  number  of  deaths  ii 
a  year  to  the  population.  Under  normal  conditions  where  the  population  i; 
"  stationary  " — that  is,  neither  incx-easing  nor  decreasing  nor  subject  to  immigra 
tion  or  emigration — the  death  rate  and  the  duration  of  life  are  "  reciprocals.' 
In  such  a  i)opulation,  if  the  death  rate  is  20  per  1,000,  the  duration  of  life  will  b. 
1,000^20=50  years. 

This  relation,  however,  is  disturbed  in  most  countries  to-day,  and  especially  ii 
America,  by  immigration  and  emigration  and  by  the  birth  rate  being  in  exces 
of  the  death  rate.  Nevertheless,  death  rates,  if  compared  under  similar  condi 
tions,  furnish  a  fairly  good  index  of  vitality.  They  vary  in  different  places  an< 
at  different  times. 

Sec  2.  Mortality  in  various  regions. — In  the  registration  area  of  the  Unitec 
States  the  death  rate  is  16.5  per  1,000;  in  France  it  is  20;  in  India  42.     In  dif 
ferent  States  of  the  United  States  it  varies  from  14  in  Michigan  to  18  in  Nev. 
York. 

Sec.  3.  Vrtan  and  rural  mortality. — The  death  rate  is  higher  in  the  city  thai 
In  the  country,  and  the  larger  the  city  the  higher  the  death  rate.  In  Europeai 
countries  among  the  cities  with  the  highest  death  rate  are  Dublin  (40)  am 
Moscow  (37)  ;  among  the  lowest,  Frankfort  on  the  Main  (16)  and  Th' 
Hague  (16). 

Sec.  4.  Race  and  condition. — The  colored  death  rate  greatly  exceeds  the  white 
The  death  rate  among  the  poor  exceeds  that  among  the  rich,  being  in  Glasgov 
and  Paris  over  twice  as  great. 

Sec  5.  Mortality  historically. — Death  rates  have  been  decreasing  during  sev 
eral  centuries.  In  London,  where  now  the  death  rate  is  only  15,  it  was  durin; 
the  seventeenth  and  eighteenth  centuries  40  to  50.  and  during  1680  to  1728,  f 
period  of  pests,  it  rose  as  high  as  80.  Similar  reduction  has  also  been  experi 
enced  in  this  country.  In  Habana  the  death  rate  after  the  American  occupa 
tion  fell  from  over  50  to  about  20. 

624 


risHEE.]  NATIONAL  VITALITY.  625 

Sec.  6.  Adult  and  infant  mortality. — The  greatest  reduction  has  been  effected 
among  eliildroii,  although  thr  donth  rate  is  still  undoubtedly  high.  Statistics 
show  that  during  tht>  last  thirty  years  the  doath  rate  up  to  50  years  of  age  has 
decreased,  but  that  beyond  DO  it  has  remained  almost  stationary. 

Sec.  7.  Particular  diseases. — The  mortality  from  certain  special  diseases  has 
greatly  decreased.  The  tuberculosis  death  rate  is  now  in  England  only  one- 
third  of  what  it  was  seventy  years  ago.  The  death  rate  from  pneumonia  now 
equals  that  of  tuberculosis.  Typhoid  fever  is  decreasing.  In  Munich  during 
1850  the  mortality  was  291  per  100,000  of  population.  The  city  at  that  time 
contained  many  cesspools.  After  these  were  filled  up  the  typhoid  rate  fell  to  10 
per  100,000  in  1SS7,  making  a  reduction  of  97  per  cent.  In  Lawrence.  Mass., 
after  the  public  water  was  filtered  in  1S93  the  ty])ho id-fever  rate  fell  from  105 
to  22.  Doctor  Kober  has  shown  that  death  rates  from  typhoid  fever  are  great- 
est in  cities  in  which  the  rivers'  waters  are  polluted,  the  average  for  these 
cities  being  62,  as  compared  with  IS  for  cities  using  unpolluted  water  of 
Impounded  and  conserved  streams.  Doctor  Rosenau  concludes  that  any  com- 
muuity  having  clean  water  and  uninfected  milk  supply  may  be  free  from 
typhoid. 

Smallpox  has  greatly  decreased  since  vaccination  has  been  employed.  !■ 
Prussia  the  death  rate  per  100,000  from  smallpox  between  1846  and  1870  was 
24.  In  1874  vaccination  was  made  compulsory,  and  the  death  rate  for  the  years 
1875-76  fell  to  1.5.  Similar  figures  can  be  given  for  other  place.s.  The  present 
outcry  against  vaccination  is  based  on  misinformation  and  on  the  general  rea- 
soning that  it  is  unnatural  to  introduce  a  poison  into  the  blood.  Statistics  show 
clearly  that  vaccination  decreases  smallpox  and  lengthens  life.  Even  though  it 
were  shown  that  the  virus  is  injurious,  it  would  be  the  lesser  of  two  evils. 

Yellow  fever  in  Philadelphia  in  1793  caused  the  death  of  one-tenth  of  the 
city's  population  within  six  and  one-half  weeks.  In  1900  it  was  found  that  a 
species  of  mosquito  transmits  this  disease.  The  result  of  this  applied  knowl- 
edge is  that  the  disease  has  practically  disappeared  in  America. 

Summary  of  Past  II. — Breadth  of  life  versus  invalidity. 

SUMMARY   OF   CHAPTER  III — PREVALENCE   OF    SERIOUS   ILLNESS. 

Section  1.  Loss  of  time. — Life  is  shortened  by  death  and  narrowed  by  inva- 
lidity. The  ideal  life,  with  respect  to  health,  would  be  free  from  illness  and  dis- 
ability of  every  kind.  To  approximate  such  an  ideal  is  the  aim  of  hygiene.  It 
is  usually  true  that  the  healthier  a  life  the  longer  it  will  last.    Humboldt  main- 

'  tained  that  he  had  lived  four  working  lives  by  retaining  a  working  power  double 
the  average  for  double  the  average  number  of  years.     According  to  Farr,  for 

I  every  death  there  is  an  average  severe  sickness  of  two  years,  or  for  each  death 
per  year  there  are  two  persons  sick  throughout  the  year.  This  would  mean  in 
the  United  States  that,  as  there  are  about  1,500,000  annual  deaths,  there  will 
always  be  about  3,000.000  persons  on  the  sick  list,  which  is  equivalent  to  about 
thirteen  days  per  capita. 

Sec.  2.  Particular  diseases. — There  are  constantly  ill  in  the  United  States  of 
tuberculosis  about  500,000  persons,  of  whom  about  one-half  are  totally  incapac- 
itated, while  the  remainder  are  half  incapacitated.  The  causes  of  various 
diseases  are  closely  interwoven.  Professor  Sedgwick  tells  us  that  "  Hazen's 
theorem  "  shows  for  every  death  from  typhoid  fever  avoided  by  the  purification 
of  a  polluted  water  supply  two  or  three  deaths  are  avoided  from  other  causes. 
Hook-worm  disease  in  the  South  is  a  chief  cause  of  incapacitation,  especially 
among  the  poor  whites.  For  this  reason  the  hook  worm  has  been  nicknamed  the 
"  germ  of  laziness."  It  is  believed  that  a  sufferer  from  hook-worm  disease  is 
incapacitated  from  one-fourth  to  one-half  of  the  time. 

The  number  of  syphilitics  in  the  United  States  has  been  estimated  at  2,000,000, 

I  though  from  the  nature  of  the  case  this  figure  is  chiefly  conjecture.  The  social 
diseases,  syphilis  and  gonorrhea,  are  responsible  for  the  existence  of  a  large 
proportion  of  defectives  of  various  kinds  which  fill  our  institutions.    Among  the 

I  troops  in  the  Philippines  the  venereal  morbidity,  during  the  year  1904,  was  297 
per  1,000,  largely  exceeding  the  morbidity  from  malarial  fevers  and  diarrhea,  as 
22  out  of  every  1,000  soldiers  were  constantly  ineffective  from  venereal  disease — 
four  times  as  many  as  from  any  other  disease.  The  statistics  outside  of  army 
and  navy  service  are  impracticable,  but  there  is  some  reason  to  believe  that  they 
might  show  an  even  larger  morbidity.  The  social  diseases,  which  certainly  art 
preventable,  are  one  of  the  gravest  of  the  menaces  to  national  efficiency. 


626  REPORT    OF    NATIONAL   CONSERVATION   COMMISSION. 

American  railways  In  1907-8  killed  nearly  11,800  and  injured  nearly  111,000 
persons.  The  deaths  and  disablements  from  accidents  in  industry,  although 
less  carefully  recorded,  also  represent  a  great  and  needless  impairment  of 
efficiency. 

SUMMABY    OF    CHAPTEB    IV — PREVALENCE    OF    MINOR    AILMENTS. 

Section  1.  Importance  of  minor  ailments. — Minor  ailments  are  far  more  com- 
mon than  most  persons  realize.  They  are  chiefly  functional  disorders,  such  as  of 
the  stomach,  heart,  nerves,  liver,  kidney,  etc.  These  deserve  more  attention 
than  they  have  hitherto  received,  because  they  are  the  gateway  to  more  serious 
troubles.  For  instance,  those  who  neglect  colds,  or  what  seem  to  be  colds, 
will  be  far  more  likely  to  become  victims  of  tuberculosis  or  pneumonia.  No 
statistics  of  the  prevalence  of  minor  ailments  exist.  Physicians,  whose  experi- 
ence gives  them  good  opportunity  to  judge,  place  the  time  lost  annually  for  each 
person  from  minor  ailments  at  three  or  more  days  a  year.  i 

Sec.    2.  PreveniahiUty    of   minor   ailments. — Practically    all    minor    ailments  : 
can  be  avoided  by  proper  hygiene,  public  and  private.    Neurasthenia,  so  common 
in  America,  is  one  of  the  most  serious  and  insidious  introductions  to  grave 
disorders,  and  is  usually  due  to  needless  worry  or  failure  to  have  adequate 
recreation. 

SUMMARY    OF    CHAPTEB    V — PREVALENCE    OF    UNDUE    FATIGUE. 

Section  1.  Strength,  endurance,  and  fatigue. — Strength  is  measured  by  the 
force  a  muscle  can  exert  once ;  endurance  by  the  number  of  times  it  can  repeat 
an  exertion  requiring  a  specified  part  of  the  strength.  Fatigue  is  a  chemical 
effect,  due  to  "  fatigue  poisons."  Far  greater  differences  exist  between  differ- 
ent persons  in  respect  to  endurance  than  in  respect  to  strength.  Some  "  well " 
people  become  tired  by  a  short  walk,  while  others  withstand  hours  of  walk- 
ing, running,  or  climbing. 

Sec.  2.  Alcohol  and  fatigue. — The  "Committee  of  Fifty"  found  that  alcohol 
gives  no  persistent  increase  of  muscular  power.  It  is  well  understood  by  all 
who  control  large  bodies  of  men  engaged  in  physical  labor  that  alcohol  and 
effective  work  are  incompatible.  Rivers,  writing  on  the  influence  of  alcohol  on 
fatigue,  found  that  when  workmen  were  provided  with  a  moderate  amount  of 
wine  it  resulted  in  a  considerable  diminution  of  their  capacity  for  work. 

Sec.  3.  Tobacco  and  fatigue. — Athletes  recognize  that  smoking  interferes 
with  one's  "  wind  "  or  "  staying  power."  "  Inhaling "  tobacco  smoke  brings 
carbon-monoxide  directly  into  the  blood  stream.  It  is  found  that  smoking  in- 
creases blood  pressure,  which  fact  possibly  partly  explains  the  reduction  in 
endurance. 

Sec.  4.  Diet  and  fatigue. — When  excessive  amounts  of  the  protein  element 
in  food  (exemplified  in  white  of  egg  or  the  lean  part  of  meat)  are  taken,  they 
putrefy  in  the  large  intestine,  producing  "  auto-intoxication."  For  this  and 
other  reasons,  there  is  a  present  tendency  among  physiologists  to  advise  a 
reduction  in  the  use  of  such  foods  from  the  amounts  customary  in  many  coun- 
tries, and  especially  in  the  United  States.  Auto-intoxication  induces  fatigue. 
The  endurance  of  those  using  high  protein  and  of  those  using  low  protein  shows 
in  general,  although  with  some  exceptions,  that  the  former  have  less  endurance 
than  the  latter.  Whether  the  latter  are  vegetarian  or  not  does  not  seem  to 
matter.  Experiments  show  that  thorough  mastication  leads  instinctively  to  a 
reduction  in  protein. 

Sec.  5.  Exertion  and  fatigue. — Oxygen,  whether  taken  naturally  or  artificially, 
increases  the  capacity  for  exertion.  A  judicious  amount  of  exercise  is  per- 
haps the  chief  factor  in  producing  the  highest  state  of  muscular  efficiency. 
Physical  training,  comprising  exercise  and  other  hygienic  measures,  will  prob- 
ably make  the  capacity  to  withstand  great  exertion  three  or  four  times  that 
possessed  by  most  persons. 

Sec.  6.  The  working  day. — The  present  working  day,  from  a  physiological 
standpoint,  is  too  long,  and  keeps  the  majority  of  men  and  women  in  a  con- 
tinual state  of  overfatigue.  It  starts  a  vicious  circle,  leading  to  the  craving 
of  means  for  deadening  fatigue,  thus  inducing  drunkenness  and  other  excesses. 
Experiments  in  reducing  the  working  day  show  a  great  improvement  in  the 
physical  efficiency  of  laborers,  and  in  many  cases  results  in  even  increasing 
their  output  sufficiently  to  compensate  the  employer  for  the  shorter  day.    Several 


FISHER.]  NATIONAL   VITALITY.  627 

examples  of  such  a  result  exist,  but  the  real  justification  for  a  shorter  work  day 
l8  found  in  the  interest  of  the  race,  not  tlio  eu]])loyer.  One  coniiKiny,  which 
keeps  its  factory  going  night  and  day,  found,  on  changing  from  two  shifts  of 
twelve  hours  each  to  three  shifts  of  eight  hours  each,  th.it  tlie  efliciency  of  the 
men  gi-adually  increased,  and  the  days  lost  per  man  by  illness  fell  from  seven 
and  one-half  to  five  and  one-half  per  year.  Public  safety  requires,  in  order  to 
avoid  railway  collisions  and  other  accidents,  the  prevention  of  long  hours,  lack 
of  sleep,  and  undue  fatigue  in  workmen. 

Sec.  7.  The  impuriance  of  preventing  undue  fatigue. — The  economic  waste 
from  undue  fatigue  is  probably  much  greater  than  the  waste  from  serious  ill- 
ness. This  is  because  the  number  of  fatigued  persons  is  great  enough  to  more 
than  outweigh  the  fact  that  the  incapacitation  from  fatigue  is  relatively  small. 
Moreover,  the  relatively  slight  impairment  of  elliciency  due  to  overfatigue  leads 
to  greater  impairment  from  serious  illness.  A  typical  succession  of  events  is, 
first,  fatigue,  then  "  colds,"  then  tuberculosis,  then  death.  Tlie  prevention  of 
undue  fatigue  means  the  arrest  at  the  start  of  this  accelerating  chain  of 
calamities. 

SuMMAEY  OF  Pabt  III. — Methods  of  conserving  life. 

SUMMARY    OF    CHAPTEB   VI — CONSEKVATION   THROUGH    HEREDITY. 

Section  1.  Heredity  and  environment. — A  wise  and  farsighted  economy  will 
lead  the  nation  to  conserve  its  vital  i-esources  by  every  possible  method.  These 
resources  depend  on  two  primary  conditions,  heredity  and  hygiene,  or  conditions 
preceding  birth  and  conditions  during  life.  In  other  words,  vitality  is  partly 
inherited  and  partly  acquired.  A  sound  physical  and  mental  inheritance  is  a 
greater  asset  than  the  inheritance  of  extraneous  advantages  like  wealth.  Even 
in  the  Old  World  a  degenerate  nobility  in  the  end  receives  less  respect  than  a 
virile  middle  class.  The  effort  to  improve  vitality  reaches  its  highest  point  in  a 
nation  when  its  health  ideals  affect  marriage. 

Sec.  2.  Eugenics. — Galton,  Pearson,  and  others  are  attempting  to  found  the 
new  science  of  "  eugenics,"  by  which  is  not  meant  any  scheme  of  general  govern- 
mental interference  with  marriage,  but  the  gradual  establishment  in  public 
opinion  of  fundamental  standards.  Just  as  to-day  the  marriage  of  brother  and 
sister  is  unthinkable,  Galton  suggests  that  the  time  may  come  when  aiarriage 
which  obviously  promotes  degeneration  will  be  equally  tabooed.  The  result 
would  be,  not  to  make  marriage  more  artificial,  but  less.  Health,  beauty,  and 
vitality  are  much  more  natural  objects  of  youthful  admiration  than  titles  or 
wealth,  which  now  exercise,  for  the  most  part,  a  baneful  infiuence  on  marriage. 
To  lessen  the  esteem  for  those  false  attractions  and  increase  that  for  natural 
attractions  will  tend  not  only  to  increase  the  number  of  healthy  marriages,  but 
to  give  greater  importance  to  natural  and  normal  love.  The  effect  will  bo  felt 
both  in  bringing  about  a  larger  proportion  of  marriages  among  the  healthy  and 
a  smaller  proportion  among  the  unhealthy.  It  will  also  lead  to  a  partial  segre- 
gation by  which  the  healthy  will  to  a  large  extent  marry  among  themselves,  and 
thus  leave  the  unhealthy  either  unmarried  or  compelled  to  make  alliances  in 
their  own  class.  The  result  will  be,  in  the  struggle  for  race  supremacy,  that 
the  healthy,  thus  separated  off  from  the  relatively  unfit,  will  have  a  distinct 
advantage  both  in  the  number  of  offspring  and  in  their  vitality. 

Sec.  3.  Eugenics  and  laic. — The  only  government  influences  which  have  been 
seriously  suggested  by  eugenists  are  two :  First,  the  offering  of  prizes  or 
bounties  to  couples  who  conform  to  certain  standards,  in  the  same  way  as  the 
French  Government  has  encouraged  the  increase  of  its  population  by  offering 
Inducements  to  couples  of  the  poorer  class  who  raise  seven  or  more  children ; 
second,  to  prevent  marriage  alliances  among  criminals,  paupers,  and  the  feeble- 
minded. Some  laws  on  these  subjects  already  exist  in  Connecticut,  Michigan, 
and  especially  Indiana,  where  there  is  a  prohibition  of  marriage  of  all  persons 
suffering  from  transmissible  diseases.  It  is  also  now  provided  in  Indiana  that 
confirmed  criminals,  imbeciles,  and  rapists,  when  it  is  deemed  advisable  by 
experts,  shall  be  unsexed.  What  such  laws  might  accomplish  may  be  judged 
from  the  history  of  two  criminal  families,  the  "  Jukes "  and  the  "  Tribe  of 
Ishmael."  Out  of  3,200  descendants  from  the  founder  of  the  "Jukes"  through 
seventy-five  years,  310  were  professional  paupers,  who  spent  in  all  two  thousand 
three  hundred  years  in  poorhouses,  50  were  prostitutes,  7  murderers,  60  habitual 
thieves,  and  130  common  criminals.     The  loss  of  potential  usefulness,  cost  of 


628  EEPORT   OF   NATIONAL   CONSERVATION   COMMISSION. 

prosecutions,  expense  of  maintenance  of  Jails,  etc.,  Dugdale  estimated  to  be 
$1,300,000  In  serenty-fiTe  years,  or  over  $1,000  for  each  member  of  tbe  family. 
All  these  unfortunate  results  could  have  been  avoided  had  the  original  criminals 
In  this  family  been  sterilized  under  a  law  like  that  of  Indiana. 

We  have  the  more  agreeable  record  of  excellent  human  qualities  inherited 
through  successive  generations  in  the  Darwin,  Hohenzollern,  and  other  families. 

SUMMAET    OF    CHAPTER    VII — CONSERVATION    THROUGH    PUBLIC    HYGIENE. 

Section  1.  Municipal  hygiene. — The  benefits  of  improved  heredity  can  be  en- 
joyed only  by  future  generations.  But  we  of  the  present  day  may  conserve  our 
vital  resources  through  hygiene,  practiced  in  one  or  all  of  three  ways — public, 
semipublic,  and  personal  hygiene.  The  first  refers  to  governmental  regulation 
of  health,  the  second  to  the  professional  or  institutional  care  of  health,  and  the 
third  to  the  private  life  of  the  individual  and  the  family.  Every  city  now  has 
its  health  board,  yet  few  citizens  realize  that  the  protection  rendered  by  these 
boards  is  more  important  than  the  protection  by  the  police  or  fire  departments. 
Much  as  is  done  by  these  boards,  there  is  enormous  room  for  improvement,  both 
in  making  regulations  and  in  enforcing  them  by  the  aid  of  a  more  enlightened 
public  opinion.  The  abatements  of  the  nuisance  and  menace  from  spitting  and 
from  vitiation  by  smoke  are  cases  in  point.  Pure  air  is  one  of  the  primary 
necessaries  of  life,  but  only  a  small  fraction  of  our  countrymen  actually  enjoy 
this  boon.  To  this  end  proper  drainage  and  garbage  removal  and  clean  streets 
are  needed.  The  transmission  of  disease  by  insects,  flies,  and  vermin  needs  to 
be  checked.  A  constant  cause  of  mortality,  among  infants  especially,  is  an  im- 
pure milk  supply.  The  same  danger  exists  in  other  dairy  products,  cream, 
butter,  cheese,  and  ice  cream.  In  Washington,  owing  apparently  to  the  enact- 
ment of  a  law  in  1895  regulating  the  sale  of  milk,  the  death  rate  from  diarrhea 
and  inflammation  of  the  bowels  among  children  under  2  years  of  age  was  re- 
duced from  160  or  170  to  135,  then  109,  104,  and  in  1906  to  97.  Similar  reports 
come  from  many  other  cities  in  this  country  and  abroad. 

Sec.  2.  State  hygiene. — The  regulation  of  the  labor  of  women  and  children 
is  usually  a  state  matter.  It  has  been  suggested  by  Doctor  Stiles  that  every 
woman  should  be  allowed  once  a  month  to  leave  a  factory  without  being  asked 
questions  or  losing  wages.  The  employment  of  mothers  before  and  after  child- 
birth should  be  prohibited,  as  it  is  now  in  a  number  of  European  countries. 
This  single  reform  would  help  greatly  to  conserve  the  vitality  of  the  next 
generation.  Child  labor  in  the  South  is  in  many  cases  the  lesser  of  two  evils, 
the  other  being  exposure  to  the  hook-worm  disease  on  polluted  farms.  In 
these  cases,  the  abolition  of  child  labor  should  be  preceded  by  the  abolition  of 
hook-worm  disease.  Hours  of  labor  have  been  steadily  decreasing,  and  should 
be  decreased  further.  Accidents  are  unnecessarily  frequent  on  our  American 
railroads,  as  well  as  in  industrial  establishments.  Statistics  do  not  exist  for 
the  latter.  Special  trades  have  special  dangers.  Among  such  trades  are  those 
using  lead  and  other  dangerous  poisonous  chemicals,  as  well  as  the  dust- 
producing  trades  which  tend  to  pulmonary  troubles.  The  dark  room  tenements 
are  a  common  means  in  our  large  cities  of  depleting  national  vitality. 

Sec.  3.  Federal  hygiene. — This  includes  quarantine,  the  inspection  of  im- 
migrants and  exclusion  of  those  with  infectious  diseases,  administration  of 
government  hospitals,  of  pure-food  laws  and  meat  inspection,  and  cooperation 
with  state  boards  of  health  in  fighting  yellow  fever,  bubonic  plague,  etc. 
Federal  power  needs  extension,  however.  Our  interstate  railroads  should  be 
improved  in  respect  to  the  sanitation  of  sleeping  cars,  smoking  cars,  etc. 

The  movement  to  secure  a  more  intelligent  national  organization  of  health 
Is  now  being  pushed  by  the  President,  President-Elect,  and  Members  of  Con- 
gress, and  has  found  expression  in  the  recent  platforms  of  both  political  parties. 
What  is  needed  is  that  the  Federal  Government  should  make  the  national 
capital  a  model  of  sanitation,  should  provide  for  more  investigation  in  health 
matters  and  the  dissemination  of  information  on  the  prevention  of  tuberculosis, 
etc.,  should  cooperate  further  with  state  and  municipal  authorities,  and  should 
check  the  pollution  of  interstate  streams  and  prevent  the  transmission  of  dis- 
ease-bearing meats  or  other  food  from  one  State  to  another.  Lastly,  It  should 
secure,  through  whatever  constitutional  means  exist,  some  method  of  collecting 
statistical  information  as  to  our  national  mortality  and  morbidity.  Our  short- 
comings in  this  respect  are  now  a  national  disgrace.  There  is  no  accurate 
record  of  births  in  any  part  of  the  United  States,  and  that  of  deaths  includes 
less  than  half  our  population.    As  a  statistician  has  said  of  one  of  the  States, 


risHKH-l  NATIONAL   VTTALrTT.  629 

"  It  buries  Its  dead  people  with  no  mere  ceremony  than  It  bnrles  Its  dead  dof!;s." 
Obviously,  no  Intelligent  control  of  epidemics  and  other  diseases  can  be  made 
unless  the  facts  in  regard  to  those  diseases  arc  known;  in  other  words,  unless 
there  exist  mortality  and  morbidity  statistics  of  real  value. 

BUMMABT    OF    CHAPTER   \^1I — CONSERVATION    THROUGH    8EMIPTJBLI0    HYGIENEL 

Section  1.  Medical  research  and  instruction. — Semipublic  hygiene  comprises 
that  relating  to  institutions  and  the  medical  profession.  The  hygiene  of  the  future 
must  depend  more  on  discoveries  in  preventive  medicine  than  on  any  other 
single  factor,  and  institutions  such  as  the  Tastour  Institute,  the  Rockefeller 
and  the  Carnegie  institutes,  and  the  research  laboratories  of  the  Government 
and  universities  offer  the  most  promising  means  of  increasing  this  most  useful 
and  iirnetieal  of  all  linnuin  knowledj^e.  The  knowledge  is  dispensed  through 
medical  schools  in  the  training  of  physicians.  These  schools  are  imijroving  so 
as  to  introduce  more  of  hygiene  and  preventive  medicine.  We  are  still  far, 
however,  from  having  facilities  for  training  public  health  oflicers,  or  giving 
them  such  a  degree  as  D.  P.  H.  (diploma  of  public  health),  as  is  given  in 
England. 

Sec.  2.  The  medical  profession. — Antiseptic  surgery  has  in  the  last  century 
been  the  greatest  triumph  of  the  medical  profession,  and  has  given  it  a  greater 
prestige  than  ever  before.  It  has  greatly  reduced  the  mortality  from  opera- 
tions, and  is  illustrated  by  the  figures  in  army  operations.  The  mortality  of  the 
wounded  in  the  Crimean  war  among  English  troops  was  15  per  cent.  The 
mortality  in  the  Transvaal  war,  1000-1901,  was  less  than  6  per  cent. 

In  the  practice  of  medicine,  the  tendency  is  progressively  to  give  up  the  use 
of  violent  drugs  and  to  depend  more  on  hygiene.  Through  the  modern  fight 
against  tuberculosis,  physicians  have  come  to  prescribe  fresh  air  in  their  prac- 
tice generally.  They  are  now  turning  in  like  manner  to  exploit  the  resources 
of  diet,  exercise,  bathing,  and  mental  hygiene. 

There  is  danger  that  these  new  fields  will  be  preempted  by  quacks.  Many 
quacks  to-day,  far  from  using  patent  medicines,  oppose  the  use  of  any  drugs 
whatever.  In  order  that  modern  hygiene  shall  be  applied  by  trained  physicians, 
it  is  necessary  that  they  provide  more  facilities  in  this  direction.  The  leaders 
of  the  profession  are  making  every  effort  to  raise  all  members  of  their  profes- 
sion to  their  own  high  standard.  This  standard  not  only  aims  to  prevent  mal- 
practice and  unethical  operations,  but  to  set  an  example  to  the  people  in  public 
service  and  in  personal  hygienic  living. 

Sec  3.  Institutional  hygiene. — Hospitals  have  done  much  to  prevent  disease 
by  segregating  infectious  cases.  Institutions  for  the  deaf  and  blind  and  other 
defectives  have  led  to  a  better  utilization  of  their  powers.  Institutional  care  of 
the  insane  has  done  much,  too,  but  can  do  more.  Mental  hygiene  as  a  whole  needs 
to  be  more  carefully  studied  and  taught  in  all  its  relations — heredity,  alcohol, 
syphilis,  and  environment. 

The  modern   sanitarium   has  become  a  useful   institution   for  prevention  of 
serious  illness,  as  distinct  from  the  hospital,  of  which  the  function  has  been  to 
cure.     Department  stores,  hotels,  and  other  commercial  institutions  are  install 
ing  ventilating  and  other  hygienic  apparatus.     The  churches  are  also  taking 
part  in  the  health  movement,  especially  the  Emmanuel  Church  in  Boston. 

Sec  4.  School  hygiene. — The  hygiene  of  school  children  is  especially  impor- 
tant because  of  its  application  to  human  life  in  its  early  stages.  There  is  a 
world-wide  movement,  led  by  Switzerland  and  some  other  countries  of  Europe, 
to  obtain  and  apply  knowledge  of  how  to  educate  the  mind  without  weakening 
the  body.  As  it  is,  school  children  are  especially  exposed  to  contagious  dis- 
eases, which  under  present  conditions  often  sweep  through  a  whole  school  be- 
fore the  local  health  board  even  hears  of  it.  Quite  as  serious,  if  not  more  so,  is 
the  protecting  of  school  children  from  imperfect  seating,  lighting,  ventilation, 
and  sanitation. 

Backward  children,  with  defects  of  eye,  ear,  nose,  or  throat,  are  numerous, 
but  experiments  have  shown  that  the  majority  could  be  improved  both  in  intel- 
lect and  in  morals. 

In  respect  to  school  hygiene,  it  is  not  so  much  lack  of  knowledge  as  lack  of 
application  of  knowledge  which  is  at  fault.  In  order  to  find  and  then  correct 
defects  of  eyes,  ears,  teeth,  etc.,  and  properly  apply  our  knowledge,  medical 
Inspection  is  necessary.  Such  inspections  as  have  been  made  disclose  an 
natonishing  amount  of  ill  health,  the  percentage  of  morbidity  being  from  20  to 
60  per  ceat.     The  committee  on  physical  welfare  of  school  children   in  New 


630  EEPOET   OF   NATIONAL  CONSERVATION   COMMISSION. 

York  found  that  66  per  cent  needed  medical  or  surgical  attention  or  better 
nourisbment;  40  per  cent  needed  dental  care;  38  per  cent  had  enlarged  glands 
of  the  neck ;  31  per  cent  had  defective  hearing ;  18  per  cent  had  enlarged  tonsils. 

Eye  strain  is  a  particular  evil  of  civilization,  and  makes  its  first  appearance 
In  school  when  the  scholar  tries  to  accommodate  the  eye  to  the  short  range 
which  reading  requires,  but  for  which  the  eye  mechanism  is  not  well  adapted 
by  nature.  The  evil  effects  of  eye  strain  are  not  confined  to  that  organ,  but  ex- 
tend to  the  whole  nervous  system,  and  indirectly  to  the  whole  organism. 
Doctor  Gould,  who  has  made  a  special  study  of  this  subject,  goes  so  far  as  to 
maintain  that  "  eye  strain  is  the  chief  source  of  the  functional  diseases  of  our 
citizens." 

At  present  medical  inspection  Is  the  exception  rather  than  the  rule.  Only  70 
cities  in  the  United  States  outside  of  Massachusetts,  and  32  cities  and  321 
towns  in  Massachusetts,  have  systems  more  or  less  complete.  New  York  em 
ploys  150  physicians,  who  visit  each  public  school  once  a  day  to  examine  chil- 
dren set  aside  for  that  purpose  by  the  teacher.  In  Providence  a  fresh-air 
school  for  children  suffering  from  tuberculosis  has  been  established.  The  cost 
of  the  school  per  capita  is  about  50  per  cent  more  than  the  ordinary  schools, 
but  the  results  justify  the  expenditure. 

Our  scholars  are  being  seriously  injured  by  nervous  overstrain.  Probably 
this  is  not  because  too  much  work  is  being  required,  but  because  the  perform- 
ance of  this  work  is  not  accomplished  economically.  Some  experiments  seem 
to  indicate  that  children  could  accomplish  as  much  intellectually  with  far  less 
dissipation  of  nervous  energy  if  they  were  in  the  schoolroom  about  half  of  the 
time  now  spent  there.  High  pressure  and  long  hours  are  bad  economy  in 
schools  as  in  factories. 

Playgrounds  conserve  child  vitality  and  are  far  superior  to  formal  gymnastics. 
They  provide  physical  training  which  accords  with  child  instincts,  and  keep  the 
child  out  of  mischief  and  often  out  of  jail.  Here,  as  elsewhere,  the  suppression 
by  civilized  and  urban  life  of  the  instinct  for  play  and  amusement  is  re- 
sponsible for  much  of  what  we  call  "  crime  "  and  "  depravity."  In  school  children 
should  not  only  be  surrounded  by  hygienic  environment,  but  should  be  taught 
the  value  of  hygiene.  The  suggestion  of  an  annual  "  health  day  "  or  "  health 
week  "  may  prove  a  fruitful  one  for  this  purpose. 

Sec.  5.  Voluntary  and  business  organizations. — Societies  to  prevent  the  spread 
of  tuberculosis,  social  diseases,  insanity,  etc.,  or  to  advocate  labor  or  health 
legislation  (state  and  national),  are  now  numerous  and  active.  It  is  being 
found  that  philanthropy  and  profit  are  not  always  antagonistic.  Labor  organi- 
zations are  connecting  the  health  movement  with  the  eight-hour  movement. 
Farsighted  employers  are  providing  social  secretaries  to  watch  over  the  health, 
comfort,  and  happiness  of  their  employees,  and  are  often  eager  for  practical 
suggestions  in  these  matters. 

Coi-porations  that  have  installed  apparatus  for  ventilation  and  sanitation, 
even  sometimes  for  the  benefit  of  their  machinery  rather  than  their  employees, 
have  in  known  instances  gotten  back  the  cost  in  lessened  illness  and  greater 
efficiency  of  work. 

An  interesting  experiment  near  Paris  was  that  of  a  mill  employing  44  men 
and  75  women  and  children.  Largely  through  the  services,  instruction,  and 
suggestions  of  a  medical  officer  there  was  not  a  single  death  in  three  years. 

The  temperance  reform  has  to-day  a  powerful  impulse  in  the  demands  by 
employers  for  more  efficient  labor  and  by  the  public  for  greater  safety  in 
travel.  Locomotive  engineers,  conductors,  and  ship  captains  who  drink  can  not 
get  employment. 

Life-insurance  companies  may  possibly  in  the  future  realize  their  opportunity 
to  make  financial  gains  by  participation  in  the  health  movement. 

Finally,  one  of  the  greatest  potential  agencies  for  bringing  about  health  re- 
form is  the  public  press.  It  is  already  interested  and  active  in  the  movement, 
although  the  good  it  does  is  often  undone  by  inserting  quack  advertising.  This 
not  only  does  direct  harm,  but  often  ties  the  hands  of  the  editor,  preventing 
him  from  expressing  any  disapproval  of  nostrums,  however  injurious  or 
immoral. 

SUMMABY  OF   CHAPTER  IX CONSEEVATION   THROUGH   PERSONAL   HYGIENE. 

Section  1.  Its  importance. — Personal  hygiene  i..  not  only  of  direct  importance 
to  the  individual,  but  furnishes  the  public  opinion  from  which,  and  from  which 
alone,  sound  public  and  semipublic  hygiene  can  spring.    Public  hygiene  will  be 


»I8H«.]  NATIONAL,  VITALITY.  631 

Ineflfectlve  unless  supported  by  personal  hygiene.  The  milk  nnd  water  sTip]ily  of 
a  city  may  be  ideal  as  supplitHl  at  a  dwelling;,  but  may  be  carelessly  contami- 
nated there.  Observation  shows  that  many  of  the  world's  most  vital  men  and 
women  have  practiced  hygiene  and  often  thereby  turned  weak  constitutions 
Into  strong  ones.  Cornaro,  the  Venetian  nobleman,  about  to  die  at  37,  adopted 
the  "  temperate  life,"  taking  especial  care  not  to  overeat..  He  lived  to  be  nearly, 
or  quite,  100. 

Sec.  2.  Brnnvficn  of  personal  hygiene. — Personal  hygiene  comprises  hygiene 
of  environment  (air,  soil,  dwellings,  clothing),  hygiene  of  nutrition,  and  hygiene 
of  activity.  The  ideal  conditions  of  health  require  purity  in  air,  purity  and 
|)roi)er  use  of  food,  and  a  proper  balance  between  mental  and  physical  activity, 
rest,  and  sleep.  The  present  world-wide  interest  in  personal  hygiene  and 
physical  education  is  not  due  to  any  startling  discoveries,  but  to  the  rediscovery 
of  the  importance  of  truths  long  insisted  upon  by  the  medical  profession. 

Sec.  3.  The  hygiene  of  environment. — The  prime  factor  in  environment  is  the 
atmosphere.  Originally  man  was  doubtless  an  outdoor  animal.  Civilization  has 
brought  him  an  indoor  environment,  and  with  it  tuberculosis.  Experiments  In 
hospitals  have  shown  that  the  agitation  of  the  air  by  dry  sweeping  greatly 
increases  bacteria.  Air  in  a  confined  room  may  be  contaminated  by  chemicals 
contained  in  wall  paper,  plaster,  or  mortar.  The  one  place  In  which  the  indi- 
vidual has  most  control  over  his  air  supply  is  the  bedroom.  The  fashion  now  of 
sleeping  with  wide-open  windows,  or  even  out-of-doors,  is  certain  to  improve 
American  vitality.  The  windows  of  living  and  work  rooms  also  may  be  open 
even  in  winter  if  a  window  board  is  used  to  deflect  the  air  upward  and  prevent 
a  cold  stratum  forming  on  the  floor.  The  outdoor  life  or  the  abundant  use  of 
fresh  air  is  an  almost  certain  preventive  of  colds.  This  fact  was  commented 
upon  by  Franklin  over  a  century  ago,  and  has  been  rediscovered  many  times 
since,  especially  in  the  experience  of  army  troops.  The  evils  of  bad  air  are  not 
confined  to  its  chemical  content.  A  room  is  sometimes  "  close  "  simply  because 
it  is  hot  or  overmoist  or  devoid  of  any  air  current. 

The  effect  of  air  on  the  skin  and  of  radiation  of  heat  from  the  body  is  im- 
portant. Consequently,  a  proper  use  of  air  involves  a  proper  use  of  clothing, 
which  needs  to  be  both  porous  and  light. 

Closely  connected  with  air  hygiene  is  the  hygiene  of  light.  "Where  sun  and 
air  enter  seldom  the  physician  enters  often."  The  lighting  of  dwellings  and 
schoolrooms  is  especially  important  with  reference  to  the  eyes.  This  is  true  also 
of  even  the  color  and  texture  of  the  printed  page  we  read.  Probably  one-fourth 
of  all  educated  people  in  America  suffer  from  disturbances  due  more  or  less  to 
eye  strain  and  its  numerous  indirect  effects. 

Sec.  4.  The  hygiene  of  nutrition. — ^The  scientific  study  of  diet  has  only  just 
begun,  and  few  authoritative  results  can  yet  be  stated.  That  diet  has  a  dis- 
tinct relation  to  endurance  has  been  rendered  probable  by  many  investigations, 
which  seem  to  show  in  particular  that  avoidance  of  overeating,  and  especially 
of  excess  in  protein,  and  thorough  mastication  are  wholesome  rules.  In  the 
choice  of  foods  the  individual  must  be  given  a  wide  latitude.  His  own  instinct, 
restored  and  educated  by  avoiding  food-bolting  which  blunts  it,  will  probably 
be  a  truer  guide  than  the  wisest  of  physiologists.  Diseased  foods,  such  as 
oysters  polluted  with  sewage,  may  transmit  typhoid  and  other  maladies. 

Sec.  i.  Drug  habits. — Poisons,  whether  taken  into  the  body  or  produced 
within,  are  injurious.  The  commonest  form  of  intoxication  is  alcoholic.  Its 
evils  are  becoming  more  apparent  than  ever  before.  As  Metchnikoff  says,  it 
lowers  the  resistance  of  the  white  corpuscles,  which  are  the  natural  defenders 
of  the  body.  It  predisposes  to  tuberculosis  and  numerous  other  diseases. 
The  findings  of  the  "  Committee  of  Fifty  "  for  the  investigation  of  the  liquor 
problem  are  important  evidence  of  the  evils  of  the  use  of  alcohol,  and  these 
have  not  received  the  attention  which  they  deserve.  Absinthe  in  France  is 
being  recognized  now  as  a  distinct  menace  to  the  nation,  and  in  Germany 
there  is  a  tendency  toward  a  lessened  use  of  alcohol  in  all  its  forms.  But  the 
movement  against  the  abuse  of  alcohol  has  reached  its  highest  point  in 
America. 

The  evils  of  tobacco  are  less  and  are  less  appreciated.  Its  stunting  effects 
on  the  growing  child  are  especially  harmful. 

Sec  6.  Activity  hygiene. — It  is  an  encouraging  sign  of  the  times  that  baths 
are  coming  more  into  vogue,  both  through  the  private  bath  tub  for  the  wealthy 
and  the  public  baths  for  the  poor.  During  the  last  generation  the  importance 
of  exercise  has  come  to  be  acknowledged,  due  largely  to  the  growth  of  modern 
athletics.    The  athletic  ideal   of  the  Greeks  was,  however,  higher  than   that 


632  EEPORT   OF   NATIONAL   CONSERVATION   COMMISSION. 

which  now  prevails  in  this  country.  Overexertion,  physical  and  mental,  Is  one 
of  the  chief  American  faults.  The  danger  signal  of  fatigue  is  seldom  observed, 
and  the  instinct  for  recreation  and  amusement  is  often  stifled. 

Sec.  7.  Sex  hygiene. — Undue  reticence  on  this  subject  is  responsible  for  the 
general  ignorance  as  to  the  extent  to  which  the  abuse  of  the  sex  relation  is  in- 
juring this  and  every  nation,  physically,  mentally,  and  morally.  Syphilis 
poisons  the  blood  and  affects  all  parts  of  the  body.  It  makes  the  individual  a 
"  bad  risk  "  for  life  insurauce  companies  for  several  years,  and  is  likely  to  be 
transmitted  to  others  through  a  kiss  or  through  the  use  of  a  common  towel, 
while  the  danger  of  transmitting  from  husband  to  wife,  or  vice  versa,  continues 
for  many  years.  Syphilis  is  one  of  the  few  really  hereditary  diseases,  and  the 
saddest  of  all  facts  connected  with  it  is  that  the  guilty  parent  may  escape  and 
the  innocent  children  suffer.  Gonorrhoea,  while  usually  cured  without  ap- 
parent impairment  of  health,  destroys  fertility,  and  for  years  after  it  has  ap- 
parently ceased  may  be  rearoused.  It  is  responsible  for  a  large  number  of 
the  cases  of  infantile  blindness  and  for  a  larger  percentage  of  many  of  the 
serious  troubles  of  women.  The  social  diseases,  while  seldom  assigned  as  a 
cause  of  death,  are  known  to  predispose  to  other  diseases  and  greatly  to 
shorten  life. 

Sec.  8.  Personal  hygiene  in  general. — The  cumulative  effect  of  hygiene,  or  of 
lack  of  hygiene,  needs  emphasis.  Breathing,  eating,  working,  and  sleeping  are 
matters  of  daily  habit.  If  they  are  wrong,  the  evil,  however  slight,  being  re- 
peated every  day  for  many  years,  produces  cumulative  effects  more  subtle,  but 
often  more  powerful,  than  the  effects  of  sudden  infection  or  accident. 

SUMMARY   OF   CHAPTER   X ARE    HYGIENIC    MEASURES   EUGENIC? 

Section  1.  The  p7-olongation  of  toenlc  lives. — The  question  has  been  raised 
whether  reduction  in  infant  and  child  mortality  will  not  weaken  rather  than 
strengthen  the  race  by  interfering  with  natural  selection  and  favoring  the  sur- 
vival of  the  unfit.  It  is  pointed  out  that  the  mortality  at  later  ages  of  life  has 
not  decreased,  as  has  that  in  the  earlier  ages.  There  is  probably,  however,  a 
sufficient  explanation  of  this  in  the  fact  that  the  improvement  in  hygienic  living 
has  not  as  yet  affected  adults  as  much  as  children.  Parents  are  quick  to  apply 
for  the  benefit  of  their  children  new  methods  of  preventing  disease,  such  as 
sferilizing  milk,  but  do  not  take  the  same  precautions  for  themselves.  The 
hurry  and  stress  of  modern  life  has  in  fact  tended  to  produce  in  some  respects 
more  unhygienic  habits  among  adults  than  prevailed  under  the  simpler  condi- 
tions of  a  generation  ago. 

Sec.  2.  Children's  diseases  impair  both  fit  and  unfit. — It  must  be  borne  in  mind 
also  that  the  same  children's  diseases  and  other  causes  which  tend  to  kill  the 
unfit  child  also  tend  to  injure  the  proper  development  of  the  fit.  Consequently 
a  lessening  of  children's  diseases  will  have  the  effect  of  not  only  prolonging 
weak  lives,  but  also  of  prolonging  and  developing  the  strong.  Statistics,  so  far 
as  available,  appear  to  show  that  where  infant  mortality  is  the  highest,  mor- 
tality at  all  ages  is  high. 

Sec  3.  Fitness  is  relative  to  environment. — What  is  sometimes  called  degen- 
eration does  not  deserve  that  name.  A  lessening  of  physical  strength,  for 
instance,  can  not  be  called  degeneration  if  conditions  under  civilization  do  not 
require  the  same  physical  strength  as  our  barbarian  ancestors  needed.  It  is 
adaptation  to  existing  conditions  which  measures  fitness. 

Whatever  danger  of  degeneration  there  may  be  from  the  care  of  the  insane 
and  defective  classes  can  be  avoided  if  the  health  ideals  of  the  nation  are  strong 
and  broad  enough  to  meet  the  situation,  for  with  these  high  health  ideals  will 
come  a  demand  which  will  prevent  the  perpetuation  of  the  unfit  and  through 
the  mere  force  of  public  opinion  lead  in  general  to  healthier  marriages. 

Summary  of  Part  IV. — Results  of  conserving  life. 

SUMMARY  OF  CHAPTER  XI — PROLONGATION  OF  LIFE. 

Section  1.  Life  is  lengthening. — So  far  as  we  can  judge  from  statistics  of  the 
average  duration  of  life,  it  has  been  on  the  increase  for  three  hundred  and  fifty 
years,  and  is  now  increasing  more  rapidly  than  ever  before.  During  the  seven- 
teenth and  eighteenth  centuries  the  increase  was  at  the  rate  of  about  four  years 
per  century ;  during  the  first  three-quarters  of  the  nineteenth  century  the  rate 
was  about  nine  years.     At  present  in  Massachusetts  life  is  lengthening  at  the 


nsHER]  NATIONAL  VITALITY.  633 

rate  of  about  fourteen  years  per  century;  in  Europe  abont  f?eventpen ;  and  in 
Prussia,  the  land  of  medical  discovery  and  its  application,  twenty-seven.  In 
India,  ^bere  medical  progress  is  practically  unknown,  the  life  span  is  short 
(twenty-five)  and  remains  stationary. 

Sec.  2.  Table  shoxcing  further  practicable  prolongation. — It  is  possible  to 
estimate  the  effect  on  the  length  of  life  of  the  partial  elimination  of  various 
diseases.  Using  the  statistics,  experience,  and  estimate  of  IS  physicians  as 
to  the  preventability  of  each  of  the  list  of  90  causes  of  death,  we  find  that  the 
length  of  life  could  easily  be  increased  from  forty-five  to  sixty,  an  Increase  of 
one-third,  or  fifteen  years.  This  would  result  in  a  permanent  reduction  In 
death  rate  of  about  25  per  cent.  The  principal  reductions  would  be  from  infan- 
tile diarrhea  and  enteritis,  over  60  per  cent  of  which  could  be  prevented,  with 
the  result  of  an  addition  to  the  average  length  of  life  of  2.32  years.  Broncho- 
pneumonia, also  an  infant  disease,  could  be  prevented  to  the  extent  of  50  per 
cent,  whereby  life  would  be  lengthened  by  0.60  year.  Meningitis,  which  Is 
usually  fatal  at  the  age  of  two,  could  be  prevented  by  at  least  70  per  cent,  and 
this  prevention  would  lengthen  the  average  life  by  0.60  year.  Eighty-five  per 
cent  of  death  by  typhoid  fever  is  unnecessary,  and  if  avoided  would  lengthen 
life  at  least  0.G5  year.  It  would  be  feasible  to  prevent  at  least  75  per  cent  of 
cases  of  tuberculosis  of  the  lungs,  and  thereby  to  lengthen  life  by  about  two  years. 
If  the  deaths  from  violence  were  reduced  only  35  per  cent,  human  life  would  be 
Increased  by  O.SG  year.  The  prevention  of  45  per  cent  of  cases  of  pneumonia 
would  lengthen  life  by  0.94  year.  These  seven  diseases  alone  could  easily  be 
reduced  by  these  amounts  so  as  to  lengthen  life  by  eight  years.  This  could  be 
done  simply  through  insistence  by  the  public  on  pure  milk,  pure  water,  pure 
air,  and  reasonable  protection  from  accidents. 

Sec.  3.  Diagram  showing  effect  of  prolongation  at  different  ages. — If  we  take 
the  diagram  representing  the  life  table  of  Massachusetts  for  1893-1 S97,  we  may 
use  it  as  the  basis  for  constructing  an  ideal  curve  to  show  the  effect  of  preven- 
tion if  applied  according  to  the  ratios  of  prevention  given  in  the  preceding 
table.  The  results  agree  substantially  with  those  found  in  the  table  and  show 
that  about  thirteen  or  more  years  could  easily  be  added  to  the  average  duration 
of  life.  The  diagram  also  shows  the  extent  to  which  the  additional  life  would 
fall  in  different  ages.  The  per  cent  of  life  which  would  fall  to  the  ages  between 
17*  and  60,  taken  as  the  working  period,  would  remain  the  same,  namely,  about 
55  per  cent. 

Sec.  4.  Fifteen  years  a  safe  minimum  estimate  of  prolongation  possible. — 
The  estimate  of  fifteen  years  is  a  minimum  because,  first,  it  takes  no  account 
of  future  medical  discoveries,  such  as  a  method  of  curing  or  preventing  cancer 
and  of  postponing  old  age,  as  would  Metchnikoff ;  second,  it  takes  little  account 
of  the  cumulative  influence  of  hygiene.  The  full  benefit  of  hygiene  can  not  be 
felt  until  it  is  practiced  throughout  life,  and  not  at  the  approach  of  specific 
danger.  Most  so-called  "  causes  "  of  death  are  merely  the  last  straws  which  break 
the  camel's  back.  When  a  pure  water  supply  prevents  deaths  from  typhoid 
fever,  it  prevents  two  or  three  times  as  many  deaths  from  other  causes.  Third, 
it  takes  no  account  of  the  racial  effects  of  new  health  ideals  leading,  in  a  general 
way,  as  they  must,  to  healthier  marriages. 

Sec.  5.  Need  of  lengthening  human  life. — With  increase  of  knowledge  the 
period  of  education  or  preparation  for  life  must  constantly  increase.  This  fact 
creates  a  need  for  a  longer  life,  with  the  later  periods  of  life  increased  in  pro- 
portion. The  result  of  such  a  prolongation  will  be  not  the  keeping  alive  of 
Invalids,  but  the  creation  of  a  population  containing  a  large  number  of  vigorous 
old  men.  Metchnikoff  says,  "  The  old  man  will  no  longer  be  subject  to  loss 
of  memory  or  to  intellectual  weakness;  he  will  be  able  to  apply  his  great 
experience  to  the  most  complicated  and  most  delicate  parts  of  the  social  life." 

Sec.  6.  The  normal  lifetime. — It  is  usually  recognized  that  human  life  is 
abnormally  short,  but  no  exact  determination  has  ever  been  made  of  what 
constitutes  a  normal  lifetime.  Flourens  maintains  that  a  mammal  lives  five 
times  the  length  of  its  growing  period,  which  would  mean,  since  the  growing 
period  for  man  does  not  cease  until  about  30,  a  normal  human  lifetime  of 
one  hundred  and  fifty  years.  Another  method  of  estimating  normal  life  is  to 
reckon  the  length  of  normal  life  as  the  time  when  old  age  now  sets  In,  83  years. 
But  clearly,  if  Metchnikoff  is  right  in  thinking  that  old  age  itself  is  abnormal, 
the  normal  lifetime  must  exceed  S3.  Many  remarkable  cases  of  longevity  are 
on  record,  but  most  cases  of  reputed  centenarians  are  not  authenticated. 
Drakenburg's  record  was  authentic,  and  he  lived  to  be  146.    Mrs.  Wood,  of 


634  REPORT   OF    NATIONAL   CONSERVATION   COMMISSION. 

Portland,  Oreg.,  recently  died  at  120.    To  what  extent  these  exceptional  case' 
could  be  made  common  can  not,  as  yet,  be  known. 

BUMMABY    OF    CHAPTER    XII — THE    MONEY    VAXTTE    OF    INCEEASED    VITALITY. 

Section  3.  Money  appraisal  of  preventable  wastes. — Doctor  Farr  has  est 
mated  the  net  economic  value  of  an  English  agricultural  laborer  at  various  tlmt 
of  life  by  discounting  his  chance  of  future  earnings  after  subtracting  the  co; 
of  maintenance.  On  the  basis  of  this  table  we  may  construct  a  rough  estimal 
of  the  worth  of  an  average  American  life  at  various  ages,  assuming  that  on! 
three-fourths  of  those  of  working  age  are  actually  earners  of  money  or  housi 
keepers.  It  gradually  rises  from  a  value  of  $90  in  the  first  year  to  $4,200  c 
the  age  of  30,  and  then  declines  until  it  becomes  negative  for  the  higher  age 
This  estimate  assumes  $700  per  year  as  the  average  earnings  in  middle  lif 
This  is  largely  conjecture,  but  is  regarded  as  a  very  safe  estimate.  ApplyinJ 
this  table  to  the  existing  population  at  various  ages  in  the  United  States,  w 
find  that  the  average  value  of  a  person  now  living  in  the  United  States  : 
$2,900,  and  the  average  value  of  the  lives  now  sacrifled  by  preventable  deatl 
is  $1,700.  The  latter  is  smaller  than  the  former  because  the  age  of  the  dyiu 
is  greater  than  the  age  of  the  living.  Applying  the  $2,900  to  the  population  c 
eighty-five  and  a  half  millions,  we  find  that  our  population  may  be  valued  ai 
assets  at  more  than  $250,000,000,000 ;  and  since  the  number  of  preventab 
deaths  is  estimated  at  030,000,  the  annual  waste  from  preventable  deaths  ; 
630,000  times  $1,700.  or  about  $1,000,000,000.  This  represents  the  annual  pr. 
ventable  loss  of  potential  earnings. 

We  saw  in  Chapter  III  that  there  are  always  3,000,000  persons  in  the  Unite 
States  on  the  sick  list,  of  whom  about  1,000.000  are  in  the  working  period  ( 
life  and  about  three-quarters  ai'e  actually  workers  and  must  lose  at  least  $70i 
which  makes  the  aggregate  loss  from  illness  more  than  $500,000,000.  Addin 
to  this  another  $500,000,000  as  the  expense  of  medicines,  medical  attendanc 
special  foods,  etc.,  we  find  the  total  cost  of  illness  to  be  about  $1.000,000,0C 
per  year,  of  which  it  is  assumed  that  at  least  one-half  is  preventable.  Addin: 
the  preventable  loss  from  death,  $1,000,000,000,  to  the  preventable  loss  froi 
illness,  $500,000,000,  we  find  one  and  a  half  billions  as  the  very  lowest  at  whic 
we  can  estimate  the  preventable  loss  from  disease  and  death  in  this  countr; 
The  true  figures  from  the  statistics  available  may  well  amount  to  several  timf 
this  figure,  but  when  statistics  are  based  partially  on  conjecture,  they  need  t 
be  stated  with  special  caution. 

Sec.  2.  The  cost  of  cons  orv  at  inn. — In  Huddersfield  the  annual  deaths  of  ii 
fants  for  ten  years  had  been  310.  By  systematic  education  of  mothers,  tli 
number  in  1907  was  reduced  to  212.  The  cost  of  saving  these  98  lives  \vi 
about  $2,000,  or  about  $20  each.  Gen.  Leonard  Wood  declared  that  the  discovei 
of  the  means  of  preventing  yellow  fever  saves  annually  more  lives  than  wei 
lost  in  the  Cuban  war.  The  hook-worm  disease  in  the  South  impairs  tt 
earning  power  of  its  workmen  by  25  or  50  per  cent.  To  restore  this  earnin 
power  costs,  by  curing  this  disease,  on  an  average,  less  than  $1  for  each  casi 
These  and  other  examples  show  that  the  return  on  investments  in  health  ar 
often  several  thousand  per  cent  per  annum.  Probably  no  such  unexploited  o] 
portunlty  for  rich  returns  exists  in  any  other  field  of  investment.  An  actuar 
suggests  that  if  insurance  companies  should  combine  to  contribute  $200,000 
year  for  the  purT)Ose  of  improving  the  public  health,  the  cost  would  be  om 
eighth  of  1  per  cent  of  the  premiums,  and  it  would  be  reasonable  to  expect 
decrease  in  death  claims  of  much  more  than  1  per  cent.  Even  this  1  per  cet 
would  make  a  profit  of  more  than  seven  times  the  expense. 

SUMMARY  OF  CHAPTER  XIII — THE  GENERAL  VALTJB  OF  INCREASED  VITALITY. 

Section  1. — Disease,  poverty,  and  crime. — Money  estimates  of  waste  of  lii 
are  necessarily  imperfect  and  sometimes  misleading.  The  real  wastes  can  onl 
be  expressed  in  terms  of  human  misery.  Poverty  and  disease  are  twin  evi^ 
and  each  plays  into  the  hands  of  the  other.  From  each  springs  vice  and  crim< 
Again,  whatever  diminishes  poverty  tends  to  improve  health,  and  vice  versa. 

Sec.  2.  Conservation  of  naliiral  resources. — The  conservation  of  our  naturf 
resources — land,  raw  materials,  forests,  and  water — will  provide  the  fooi 
clothing,  shelter,  and  other  means  of  maintaining  healthy  life,  while  the  coi 
servation   of  health   likewise  tends  in   many   ways  to  conserve  and   increae 


risHEB.l  NATIONAL  VITALITY.  Go 5 

wealth.    The  more  vigorous  and  long-lived  the  race,  the  better  iitillzntlon  It  will 

make  of  its  natural  resources.    This  will  be  true  for  two  reasons  in  particular: 

First,  the  greater  inventiveness  or  resouroofulnoss  of  vij;orous  uiltuls  in  viKnrous 

bodies.     Civilization  consists  chiefly  in  invention  and  the  most  progressive  nations 

are  those  whose  rate  of  Invention  is  most  rapid.     Second,  the  greater  foresight 

and  solicitude  for  the  future.     As  It  is  usually  the  normal  healthy  man  who 

Iprovides  life  insurance  for  his  family,  so  It  will  be  the  normal  healthy  nation 

Iwhch  will   take  due  care  of   its   resources   for   the  benefit  of  gencrutious  yet 

i  unborn. 

I  SUMMABT  or   CHAPTER  IIV THINGS    WHICH    NEED  TO   BE  DONE. 

(  Section  1.  Ku itineration  of  principal  measures. — Federal,  stale,  and  munlclr'al 
^boards  of  health  should  be  better  appreciated  and  supported.  Their  powers  of 
hnvostigation.  administration,  and  disseminating  information  should  bo  en- 
ilarged.  School  hygiene  should  be  practiced,  and  personal  hygiene  more  empha- 
I  sized.    The  multiplication  of  degenerates  should  be  made  Impossible. 

S.  Doc.  419.  61-2 2 


INTRODTJCTIOTT. 

At  the  conclusion  of  his  Wliite  House  address  on  the  "  Conservo 
tion  of  Natural  Besources,"  President  Roosevelt  said : 

Finally,  let  us  remember  that  the  conservation  of  our  natural  resources 
though  the  gravest  problem  of  to-day,  is  yet  but  part  of  another  and  greatei 
problem  to  which  this  nation  is  not  yet  awake,  but  to  which  it  will  awake  in 
time,  and  with  which  it  must  hereafter  grapple  if  it  is  to  live — the  problem  ol 
national  efficiency. 

The  conditions  on  which  national  efficiency  depend  may  be  classi- 
fied under  three  heads:  Those  relating  to  physical  environment, 
those  relating  to  social  environment,  and  those  relating  to  human 
nature.  Under  the  first  head  comes  the  problem  of  the  conservation  oi 
land,  forests,  minerals,  and  water.  The  second  comprises  social  ques- 
tions, whether  political,  economic,  or  religious.  The  third  covers 
the  study  of  the  characteristics  of  man  himself — physical,  mental,  and 
moral. 

This  report  falls  under  the  third  head,  concerning  as  it  does  vital- 
ity, the  measure  of  life  itself,  and  the  basis  of  all  human  qualities' 
The  object  is  to  review  briefly  the  condition  of  American  vitality, 
contrasted  with  the  vitality  of  other  nations;  to  show  the  extent  to 
which  it  may  be  increased;  and  to  point  out  the  value  of  such  an 
increase  in  years  of  life,  enjoyment  of  life,  and  economic  earnings. 

The  world  is  gradually  awakening  to  the  fact  of  its  own  improvabil- 
ity.  Political  economy  is  no  longer  the  "  dismal  science,"  teaching 
that  starvation  wages  are  inevitable  from  the  Malthusian  growth 
of  population,  but  is  now  seriously  and  hopefully  grappling  with 
the  problem  of  abolition  of  poverty.  In  like  manner  hygiene,  the 
3^oungest  of  the  biological  studies,  has  repudiated  the  outworn  doc- 
trine that  mortality  is  fatality,  and  must  exact  a  regular  and  in- 
evitable sacrifice  at  its  present  rate  year  after  year.  Instead  of  this 
fatalistic  creed  we  now  have  the  assurance  of  Pasteur  that  "  It  is 
within  the  power  of  man  to  rid  himself  of  every  parasitic  disease,'' 
as  well  as  the  optimistic  writings  of  Metchnikoff  and  others. 

Many  evidences  of  a  world-wide  awakening  to  the  importance  of 
improving  human  vitality  can  be  given.  Among  them  are  the  recent 
English  parliamentary  report  of  the  interdepartmental  committee 
on  physical  degeneration  (prompted  by  the  fact  that  the  English 
army  recruits  were  decreasing  in  stature)  ;  in  America,  the  many 
societies  and  congresses  to  prevent  and  control  tuberculosis,  insanity, 
alcoholism,  social  diseases' and  vice,  and  infant  mortality;  the  growth 
of  preventive  sanatoria,  dispensaries,  and  similar  institutions:  the 
establishment  of  numerous  journals  of  preventive  medicine,  both 
technical  and  popular;  the  increased  attention  to  the  subject  of 
health  in  the  public  press;  the  spread  of  athletics  and  the  physical 
training  movement;  the  growth  of  the  custom  among  city  people  to 
636 


FisHEr]  NATIONAL   VITALITY.  637 

orpanize  country  clubs,  and  the  increasinfj  popularity  of  golf  and 
similar  recreations:  the  constant  acritation  and  U^fjfislation  in  refer- 
ence to  child  labor,  slaughterhouses,  impure  foods,  milk  supply,  and 
water  contamination:  the  increased  vigilance  of  iiealth  boards;  the 
growth  of  sick-benefit  associations  and  insurance  among  working 
men;  the  efforts  toward  improving  tiie  sanitary  surroundings  and 
houi-s  of  labor  of  workmen,  and  especially  of  women  and  children, 
and,  finally,  the  movement  to  secure  a  national  organization  of  health 
at  "Washington. 

A  number  of  universities  are  supporting  special  investigations  in 
physiology,  hygiene,  and  preventive  medicine.  Some  schools  also 
have  placed  the  allied  subjects  of  domestic  science  and  dietetics  on 
their  curricula,  while  physical  education  is  receiving  constantly  in- 
creasing attention.  Within  a  generation  every  important  college, 
school,  and  branch  of  the  Young  Men's  Christian  Association  has 
ome  to  have  a  gymnasium  and  classes  in  gymnastics.  Research  insti- 
tutions are  being  established,  such  as  the  Rockefeller  Institute  for 
Medical  Research,  the  fund  established  by  Mrs.  Sage  to  study  dis- 
eases of  old  age,  and  the  Memorial  Institute  for  Infectious  Diseases. 
The  home-economics  movement  is  rapidly  growing  and  seems  destined 
X)  improve  greatly  the  management  of  xVmerican  homes. 

The  practice  of  medicine,  which  for  ages  has  been  known  as  the 
'healing  art,"  is  undergoing  a  gradual  but  radical  revolution.  The 
jhange  is  based  on  the  conviction  that  an  ounce  of  prevention  is 
svorth  a  pound  of  cure.  As  teachers  and  writers  on  hygiene,  as 
:rainers  for  athletes,  as  advisers  for  the  welfare  departments  of  large 
ndustrial  plants,  and  in  many  other  directions,  physicians  are  find- 
ng  fields  for  practicing  preventive  medicine.  There  is  a  still  higher 
jtage  of  medical  science  than  that  of  fighting  or  preventing  disease 
n  the  individual — the  stage  which  has  been  called  "  biological  engi- 
leering,-'  i.  e.,  the  study  of  the  conditions  under  which  the  individual 
nay  reach  his  highest  efficiency.  In  the  development  of  this  science 
physicians  are  turning  from  private  practice  to  public  service  and 
ire  acting  as  health  officers  in  federal,  state,  and  city  governments, 
IS  heads  of  sanatoria  and  as  medical  inspectors  of  schools,  factories, 
nines,  and  shops.  Even  the  family  physician  is  in  some  cases  being 
itsked  by  his  patients  to  keep  them  well  instead  of  curing  them  after 
hey  have  fallen  sick. 

Finally,  we  have  also  the  suggestion  by  Sir  Francis  Galton  of  the 
lew  science  of  eugenics,  which  seeks  to  study  the  hereditary  condi- 
ions  of  human  vitality.  He  has  established  a  research  fellowship 
»n  the  subject  at  the  University  of  London.  Already  Karl  Pearson 
.nd  others  have  made  valuable  contributions  to  the  study  of  human 
legeneration,  the  effect  of  tuberculosis  on  the  race,  the  comparative 

K umber  of  offspring  of  various  classes,  and  the  extent  to  which 
lating  is  "  assortative,"  so  that  like  marries  like. 
With  all  these  facts  in  view  it  requires  no  great  prophetic  vision 
iO  see  that  among  the  rising  generation  there  will  be  a  great  move- 
aent  to  conserve  human  life  and  health.  The  power  and  success  of 
his  movement  will  depend  upon  the  realization  of  its  stupendous 
mportance.  A  chief  object  of  this  report  is,  in  a  conservative  and 
autious  manner,  to  help  make  this  importance  clear. 


Part  I.— THE  LENGTH  OF  LIFE  VERSUS  MORTALITY. 

Chapter  I. — The  length  of  life. 

Section  1. — In  different  places. 

By  those  who  have  never  considered  the  problem,  death  and  disease] 
are  accepted  as  a  matter  of  course.  In  individual  cases  it  is  recog- 
nized that  a  death  or  an  illness  might  have  been  prevented,  but  thei 
idea  that  the  death  rate  could  be  changed  in  any  appreciable  degree, 
or  controlled,  is  quite  foreign  to  the  mind  of  the  average  man. 
Charles  Babbage  wrote:  "  There  are  few  things  less  subject  to  fluctua- 
tion than  the  average  duration  of  life  of  a  multitude  of  individuals." 

If  this  statement  were  correct,  we  should  find  the  average  duration 
of  life*  and  the  death  rate  substantially  the  same  in  different  places 
and  at  different  times.  The  facts  do  not  conform  to  this  view. 
Modem  life  tables  show  that  the  average  length  of  life  in  the  leadingf 
countries  of  the  world  varies  remarkably,  as  the  following  figures 
will  illustrate.' 

Modem  duration  of  life. 


Country. 


ilulcs. 

50.9 

50.2 

45.7 

44.1 

44.1 

42.8 

41.0 

23.0 

Females. 


Sweden,  1891-1900 

Denmark,  1895-1900 

France,  1898-1903 

England  and  Wales,  1891-1900 

United  States  (Massachusetts,  1893-1897) « 

Italy,  1899-1902 

Prussia.  1891-1900 

India,  1901* 


53.6 
,53. 2 
49.1 
47.7 
46.6 
43.1 
44.5 
24.0 


•  Samuel  W.  Abbott,  M.  D.  :  "  Vital  Statistics  of  Massachusetts  for  1897,"  Thirtieth 
Annual  Report  of  the  State  Board  of  Health  of  Massachusetts,  1898. 

*  Statistiques  Generale  de  la  France:  Statistiques  Internationales,  etc.,  1907,  p.  566. 
See  also  J.  A.  Balnes,  "  The  Peradventures  of  an  Indian  Life  Table,"  .Tournal  Royal  Sta- 
tistical Society,  1908,  Vol.  LXXI,  part  2,  p.  310,  where  the  average  duration  of  life  for 
males  is  given  as  23.6. 

When  we  consider  that  the  average  duration  of  life  in  India  is 
scarcely  more  than  one-half  that  of  France  and  less  than  one-half 


"Charles  Babbage:  A  Comparative  View  of  the  Various  Institutions  for  the 
Assurance  of  Lives,  p.  15.     London,  1S26. 

*  By  average  duration  of  life  or  the  life  span  is  meant  the  average  length  of 
life  among  a  large  number  of  persons  born  taken  at  random.  It  is  not  the  same 
as  the  average  age  at  death  in  a  community  during  a  year,  since  that  com- 
munity may  contain  an  abnormally  large  proportion  of  infants,  or  of  any  other 
"  age  group." 

"  Some  of  the  figures,  especially  those  for  India,  rest  on  imperfect  data,  but 
they  are  believed  to  be  sufficiently  accurate  for  general  comparison. 

638 


MSHXR-l  NATIONAL   VITALITY.  639 

that  of  Sweden,  we  must  conclude  that  the  length  of  human  life  is 
dependent  on  definite  conditions  and  can  be  increased  or  diminished 
by  a  modification  of  those  conditions. 

Section  2. — At  different  times. 

Striking  corroboration  of  this  conclusion  is  found  as  soon  as  we 
compare  the  average  duration  of  life  at  different  periods  of  time. 
The  earliest  attempt  to  discover  a  hiw  of  human  mortality  appears  to 
be  that  of  UljMan,  a  Roman  pretorian  prefect,  about  220  A.  1).  The 
meaning  of  his  table  is  somewhat  doubtful,  but  it  is  assumed  to  refer 
to  "  expectation  of  life,"  which  for  ages  up  to  20  is  given  as  thirty 
years." 

This  estimate  is  so  crude  and  vague  as  to  be  of  little  value  for 
comparative  purposes.  Professor  Finkelnburg,  of  Bonn,  estimates 
that^ 

The  average  length  of  human  life  In  the  sixteenth  century  was  only  between 
eighteen  and  twenty  years,  and  that  at  the  close  of  the  eighteenth  century  it 
was  a  little  over  thirty  years,  while  to-day  it  is  between  thirty-eight  and  forty 
years.* 

In  Geneva  the  records  go  back  over  three  centuries  showing  the  fol- 
lowing life  span :  * 

I6th   century 21.2 

!.7th    century 25.7 

18tb    century 33.6 

1801-1SS3 39.7 

Here  we  see  an  increase  in  the  span  of  life  of  100  per  cent  in  three 
or  four  centuries.  The  last  few  decades,  moreover,  tell  a  striking  story 
of  increase.  It  is  one  of  the  boasts  of  the  nineteenth  century  that  the 
splendid  medical  and  scientific  advances  of  that  period  have  aided  in 
a  distinct  lengthening  of  life. 

In  1693  the  British  Government  borrowed  money  by  selling  an- 
nuities, and  in  1790,  a  century  later,  it  did  the  same  thing.  ^Vliile 
the  first  venture  proved  satisfactory,  the  second  caused  a  great  loss  to 
the  Government,  owing  to  the  improvement  in  longevity  which  had 
taken  place,  and  which  was  estimated,  for  the  annuitant  class,  at 
20  years.'' 

If  we  compare  Ogle's  English  life  tables  for  1871-1881  with  those 
of  Farr  for  1838-1854,  we  find  an  increase  in  life  span  of  1.4  years 
for  males  and  2.8  for  females.* 

I  "  See  Irving  Fisher:  Mortality  Statistics  of  the  United  States  Census,  Publica- 
tions of  the  American  Economic  Association,  Mouograijh  on  Federal  Census, 
ISIt'J,  p.  157.    Taken  from  Assurance  Magazine,  VI,  p.  31-1;  note. 

^  George  M.  Kober,  M.  D. :  "  Conservation  of  Life  and  Health  by  Improved 
Water  Supply,"  publications  of  conference  on  the  conservation  of  natural  re- 
sources, 190S,  p.  23.  Washington,  D.  C,  privately  published.  From  Finkein- 
burg'8  "  Organisation  der  oCCentl.  Gesundheitsphlage  in  der  Kulturstaaten  "  in 
Handbuch  der  Hygiene,  1893. 

^  From  Mnllot  in  "Annales  d'  Hygiene,"  XVII,  1G9 ;  quoted  by  Dr.  Edward 
Jarvis,  "  Political  Economy  of  Health,"  in  Fifth  Annual  Report,  Mass.  Board  of 
Health,  1874. 

<*  See  Dr.  Southward  Smith,  Transactions  P.ritish  Social  Science  Association, 
1857,  p.  498,  quoted  by  Dr.  Edward  Jarvis.  ibid. 

'  R.  Mayo-Smith;  Statistics  and  Sociology,  p.  178.     New  i'ork   (Macmillan), 

,  16U0. 


640  REPORT   OP    NATIONAL  CONSERVATION   COMMTSSTON. 

A  still  greater  improvement  has  been  effected  since  Ogle's  figures  J 
of  1871-1881 : 

Lifetime  in  England  and  Wales: 

Males — 

1838-1854 39.  9 

1891-1900 44.  1 

Females — 

1838-1854 41.  8 

1891-1900 47.  8 

Similar  improvements  are  observable  in  other  countries. 

Lifetime  in  France: 

Males — 

1817-1831 38.  3 

1898-1903 45.  7 

Females — 

1817-1831 40.  8 

1898-1903 49.  1 

Lifetime  in  Prussia : 

Males — 

1867-1877 35.  3 

1891-1900 41. 1 

Females — 

1867-1877 37.  9 

1891-1900 44.  6 

Lifetime  in  Denmark : 

Males — 

1835-1844 42.  6 

1895-1900 50.  2 

Females — 

1835-1844 44.  7 

1895-1900 53.  2 

Lifetime  in  Sweden : 

Males — 

1816-1840 39.  5 

1891-1900 50.  S 

Females — 

1816-1840 -.  43.  S 

1891-1900 53.  € 

It  is  difficult  to  obtain  American  life  tables  that  go  far  enough  back 
into  history  to  display  increases  in  the  life  span  similar  to  those  jusi 
presented;  yet  comparisons  of  Abbott's  Massachusetts  life  tables  foi 
1893-1897  with  Elliott's  Massachusetts  tables  for  1855  and  WiggleS' 
worth's  Massachusetts  and  New  Hampshire  life  tables  of  a  centurj 
ago  give  us  a  progressive  increase  from  35  in  1789  "  to  40  in  1855 ' 
and  45  in  1893-1897.''  Unfortunately  no  tables  exist  for  the  Unitec 
States  as  a  whole  from  which  similar  comparisons  might  be  made 
Good  and  reliable  vital  statistics  are  among  our  most  crying  needs 
Meech's  life  tables,  based  on  the  census  figures  of  1830,  1840,  1850 
and  1860,  showed  a  life  span  for  the  whole  country  of  42.'* 

"E.  Wigglesworth :  "Table  showing  the  probability  of  the  duration,  tin 
decrement  and  the  expectation  of  life  in  the  States  of  Massachusetts  and  Ne\< 
Hampshire,  formed  from  62  bills  of  mortality  on  the  files  of  the  Americar 
Academy  of  Arts  and  Sciences  in  the  year  1789."  Memoir  of  the  Americai 
Academy  of  Arts  and  Sciences,  Vol.  II,  p.  133. 

^  Proceedings  American  Association  for  the  Advancement  of  Science,  1857 
pp.  61  and  69. 

"Abbott,  loc.  cit. 

<*  Levi  W.  Meech :  System  and  Tables  of  Life  Insurance,  ed.  of  1886,  p^ 
255-259.  The  figures  for  life  span  at  different  periods  given  in  this  paragrapl 
have  been  secured  by  averaging  the  figures  for  males  and  females. 


iisHBB.]  NATION ALi  VITALITY.  641 

The  census  of  1880  gave  some  70  sets  of  life  tables  for  different 
registration  States  and  cities.  The  expectation  of  life  for  white 
males  was  given  for  Massachusetts  as  44,  New  Jersey  40,  District  of 
Columbia  41,  and  New  York  City  33,  but  in  constructing  the  tables 
"the  census  was  too  prodigal  as  to  quantity  and  somewhat  careless  as 
to  quality.  It  is  difficult  to  separate  the  wheat  from  the  chaff.  The 
table  sliould  have  been  accompanied  by  a  running  criticism.  The 
general  defect  was  that  no  attempt  was  made  to  correct  the  deficiencies 
in  the  returns  for  infants.""  The  census  for  1890  gives  only  a  few 
life  tables,  and  that  for  1900  none. 

In  striking  contrast  to  these  recent  increases  of  the  life  span  in 
progressive  countries  is  the  table  for  backward  India,  which  showed 
no  advance  in  twenty  years." 

Lifetime  in  ludia : 
Males — 

1881 23.7 

1901 23.6 

Chapter  II. — The  mortality  rate. 
Section   1. — Relation   of  longevity   and  mortality. 

The  average  duration  of  life  and  the  death  rate*^  are  two  comple- 
mentary magnitudes.  An  increase  in  the  life  span  means  a  decrease 
in  the  death  rate,  and  vice  versa ;  in  fact,  in  a  "  stationary  "  popula- 
tion (a  population  in  which  the  annual  number  of  deaths  equals  the 
annual  number  of  births,  and  without  emigration  or  immigration), 
it  will  be  true  that  the  average  duration  of  life  and  the  death  rate 
are  mathematically  the  "  reciprocals  "  of  each  other.*^  Thus,  if  the 
death  rate  is  20  deaths  per  annum  for  each  1,000  of  population  (i.  e., 
twenty  one-thousandths  per  annum),  the  average  duration  of  life 
«rould  be  J^5§°-  =  50  years. 

If  this  reciprocal  relation  between  duration  of  life  and  mortality 
held  true  in  every  poiDulation,  it  would  be  easy  to  translate  death 
rates  into  average  duration  of  life,  and  conversely;  but  unfortunately 
such  a  simple  calculation  is  impracticable  under  conditions  existing 
in  America,  and  even  in  most  countries  of  Europe.  With  the  ex- 
1 1  ption  of  France,  few  countries  have  even  approximately  an  equality 
I  iween  deaths  and  births  and  an  absence  of  emigration  and  im- 
migration. In  America,  where  the  deaths  are  exceeded  by  the  births, 
and  where  there  is  a  large  immigration  of  j^oung  men  and  women  in 
t!ie  prime  of  life,  the  death  rate  is  smaller  than  it  would  be  if  our 
population  were  "  stationary."    The  annual  death  rate  in  the  United 

"  Fisher :  Mortality  Statistics  of  the  United  States  Census,  American  Eco- 
nomic Association  Monograph  on  the  Federal  Census,  1899,  p.  160. 

'^Baines:  "The  Peradventures  of  :in  Indian  Life  Table,"  Journal  of  the 
Royal  Statistical  Society,  1908,  Vol.  LXXL,  pt.  2,  p.  310. 

'"A  death  rato  is  the  ratio  of  the  numljor  of  deaths  during  a  year  to  the  popu- 
lation, taken  at  some  point  in  the  year,  usually  the  middle. 

'^  For  a  short  explanation  of  this  reciprocal  relation,  which  is  more  fully 
explained  in  works  on  actuarial  science,  see  I^isher :  Mortality  Statistics  of  the 
United  States  Census,  pp.  149-150.  It  is  interesting  to  see  the  grjiphic  tn- 
torpretation  of  this  reciprocal  relation  by  means  of  the  diagram  in  Chapter 
XI  of  this  Report. 


642  KEPOET   OF   NATIONAL  CONSERVATION   COMMISSION. 

States  is  probably  about  18  per  thousand"  of  population.  The 
reciprocal  of  this  would  be  l,000-f-18,  or  55  years,  which  is  altogether 
too  high  an  estimate  for  the  average  length  or  life  in  the  United, 
States. 

It  is  possible  to  "  correct "  the  death  rate  for  "  age  distribution  "  sol 
that  its  reciprocal  will  be  the  true  average  duration  of  life,  but  the 
calculation  is  a  difficult  and  tedious  one.  We  are  forced,  therefore, 
to  get  along  in  most  cases  with  the  "  crude  death  rate,"  or  the  quo- 
tient of  the  number  of  deaths  in  a  year  divided  by  the  population. 
This  figure  is  much  easier  to  obtain  than  a  corrected  death  rate  or  its 
reciprocal,  the  average  duration  of  life. 

Our  data  for  death  rates  are  far  more  voluminous  than  our  data 
for  the  average  duration  of  life.  Although  theoretically  death  rates 
are  not  an  unerring  indication  of  longevity,  they  furnish  in  practice 
very  valuable  information.  In  a  general  way  death  rates  may  be 
compared  with  each  other,  especially  in  the  same  community.  For 
instance,  a  decrease  in  the  death  rate  in  New  York  City  from  one  year 
to  another  is  practically  a  certain  indication  of  improvement  in  vital 
conditions. 

Section  2. — Mortality  in  various  regions.  i 

Forty  years  ago  the  variations  in  the  death  rates  of  the  different 
sections  of  Europe  were  given  by  Quetelet  ^  as  follows : 

Death  rate  per  1,000  population. 

Northern    Europe 24.  3i 

Central   Europe 24.  5 

Southern    Europe 29.  7 

To-day  the  death  rates  of  various  countries  compare  with  each 
other  as  in  the  following  table : 

Modem  death  rates  per  1,000  of  population.^ 

Denmark  (3906) 13.5 

Sweden    (1906) 14. 4 

England  and   Wales    (1906) 15.4 

United   States    (registration   area)     (1907) 16.5 

Germany   (1905) 19.8 

France     (1906) 19.9 

Italy     (1906) 20.8 

Japan    (1905) 21.9 

India   (males,<J  1901) 42.3. 

As  we  found  in  the  study  of  duration  of  life,  so  we  find  here  wide' 
variations  from  country  to  country.  Italy  presents  a  death  rate 
larger  by  nea^rly  one-sixth  than  that  of  the  United  States,  while 
famine-tortured  and  plague-ridden  India's  mortality  rate  is  twice 
that  of  France  and  three  times  the  rates  of  Denmark  and  of  Sweden. 

«W.  F.  Willcox:  "Death  Rate  of  the  United  States  in  1900,"  publications 
of  the  American  Statistical  Association,  Vol.  X,  p.  155. 

*  Quetelet,  Physique  Sociale,  Vol.  I,  p.  281.  These  figures  refer  to  the  ex- 
perience of  different  periods  between  ISOl  and  1831. 

<'  With  the  exception  of  the  figures  for  India,  this  table  is  taken  from  figures 
furnished  by  the  Bureau  of  the  Census. 

<*  Baiues,  loc.  cit.,  p.  310. 


risHEB.]  NATIONAX,  VITALITY.  643 

Even  the  fairly  homogeneous  population  of  our  registration  States 
in  America  shows  variations  in  death  rates." 

Death  rate  per  1,000  population  in  1900. 

Michigan 13.9 

Vernioiit IT.  0 

Massachusetts 17.  7 

New  York 17.  9 


The  death  rate  in  Michigan,  at  the  one  extreme,  is  thus  but  three- 
'  fourths  that  of  New  York  at  the  other  extreme.    This  difference  may 
probably  be  accounted  for  in  part  by  the  difference  in  the  age  con- 
stitution, as  the  population  for  Michigan  contains  a  larger  propor- 
tion of  population  in  young  and  vigorous  life  than  does  New  York. 

Section  3. — Urian  and  rural  mortality. 

Comparison  of  urban  and  rural  death  rates  also  gives  us  varia- 
tions.^ 

Death  rates  per  1,000  population  in  1900. 

Massachusetts : 

Urban 17.9 

Rural 17. 1 

Michigan : 

Urban 15.3 

Rural 13.  3 

New  Jersey : 

Urban  18.  8 

Rural 15.  5 

Interesting  comparisons  may  be  made  of  the  death  rates  of  Ameri- 
can cities  varying  in  size  and  location.  The  death  rate  per  1,000  of 
population  in  1906  was  given  "^  as  14.2  (probablv  incorrect)  in  Chicago, 
in  Boston  18.9,  in  New  York  18.6,  and  in  Philadelphia  19.3.  Cleve- 
land, Ohio,  was  credited  with  a  death  rate  of  but  16,  while  Cincinnati, 
in  the  same  State,  had  20.8.  The  causes  of  such  differences  are  not 
always  attributable  to  variations  in  size.  New  Haven,  for  instance, 
a  larger  Connecticut  city  than  either  Hartford  or  New  London,  had  a 
lower  death  rate  in  1900  by  2.2  and  2.5,  respectively,  per  1,000  popu- 
lation. The  differences  are  accounted  for  partly  by  differences  in 
age  constitution,  partly — it  is  unfortunatel}''  true — by  differences  in 
the  accuracy  of  the  collected  statistics,  partly  by  differences  in  size 
and  location,  and  partly  by  differences  in  the  vigilance  of  the  public 
and  private  health  authorities. 

European  cities  show  even  greater  variations  in  mortality  than 
these  just  given  for  the  United  States. 

«  Twelfth  Census  of  the  United  States,  Vol.  Ill,  p.  LVIII. 

i"  United  States  Census  Bulletin,  No.  88,  1901. 

*  Seventh  Annual  Census  Report  on  Mortality  Statistics,  1906. 


644 


BEPOKT   OF   NATIONAL  CONSEEVATION   COMMISSION. 


Death  rates  of  European  cities  per  1,000  population,  1S07: 


Locality. 

High. 

Locality. 

Low. 

Dublin 

39.9 
36.9 
31.3 
31 

Frankfort  on  the  Main 

15  0 

Moscow 

The  Hague 

16  2 

Belfast 

Berlin. . 

17 

St.  Petersburg 

Amsterdam 

17.8 

« One  must  doubt,  however,  the  accuracy  of  some  of  these  figures,  especially  the 
Russian.  The  rates  in  Moscow  and  St.  Petersburg  in  1906  are  reported  as  25.8  and  25.5, 
respectively,  which  do  not  comport  with  the  rates  for  1S97. 

Section  4. — Race  and  condition. 

The  variations  in  death  rates  among  different  races  are  well  known. 
The  black  race,  for  example,  always  suffers  a  higher  mortality  than 
the  white.  In  Boston  during  the  half  century  from  1725  to  1774  the 
death  rate  per  1,000  is  given  as  ranging  from  56  to  87  for  the  blacks 
and  only  from  30  to  41  for  the  whites.  Thus  the  maximum  white 
death  rate  was  lower  than  the  minimum  black  death  rate.* 

In  1906  the  death  rate  per  1,000  in  all  registration  cities  having  not 
less  than  10  per  cent  colored  inhabitants  was  17.2  for  whites  and  28.1 
for  blacks. 

These  racial  differences  may  be  ascribed  in  part  to  different  habits 
and  conditions  of  life,  but  probably  in  part  also  to  varying  racial 
susceptibility  to  disease. 

The  relation  of  social  status  to  the  rate  of  mortality  has  been  often 
discussed  and  offers  a  partial  explanation  of  racial  or  national  varia- 
tion of  death  rate.  That  a  well-to-do  class,  properly  fed  and  clothed 
and  with  opportunity  for  leisure,  will  be  less  susceptible  to  disease 
and  death  than  a  poverty-stricken  class,  ill-fed  and  overworked,  has 
been  repeatedly  shown  by  statistics.  Newsholme  has  stated,''  for  ex- 
ample, that  in  Glasgow  the  death  rate  among  tenants  of  large  houses 
is  much  lower  than  among  the  tenants  of  smaller  dwellings : 


One  and  two 
room  houses. 


Three  and 

four  room 

houses. 


Five  rooms 
and  over. 


Death  rate  per  1,000  occupants  in  1885. 


27.7 


19.5 


n.3 


In  Paris  comparison  has  been  made  between  two  quarters  known  to 
be  rich,  on  the  one  hand,  and,  on  the  other,  a  third  quarter  known  to 
be  poor. 

Death  rate  per  1,000  population." 
Rich  quarters: 

Elysee 13.4 

Opera 16.  2 

Poor  quarter : 

Menilmontant 31.  3 


"  Lemuel  Shattuck,  "  Tlie  Vital  Statistics  of  Boston,"  p.  xiii.  Reprinted  in 
"  Bills  of  Mortality,  1810-1849,"  city  of  Boston,  1893. 

*  Arthur  Newsholme,  "Vital  Statistics,"  London  (Swan  Sonnenschein),  1899, 
p.  163. 

«  E.  Levasseur,  "  La  Population  Francaise,"  Paris,  1891,  Vol.  II,  p.  403. 


riSEBK.] 


NATIONAL.  VITALITY. 


645 


In  Russia  a  similar  comparison  has  been  made  between  peasants 
who  own  no  Lmd,  those  who  own  less  than  13^  acres,  those  who  own 
between  13i  and  40^  acres,  and  so  on  up  the  scale  of  proprietorship." 

Peasant  death  rate  per  1,000,  Oovernnicnt  of  Voronezh,  1889-1891. 


Class  of  household. 


For  1,000. 


Having  no  land 

Having  less  than  13.5  acres 

Havitisj  13.0  and  less  than  40.5  acres 
Havinj,'  40.5  and  less  than  (J7.5  acres 
Having  67.5  and  less  than  135  acres 
Hsving  more  than  135  acres 


34.7 
32.7 
30.1 
25.4 
23.1 
19.2 


Occupational  comparisons  are  often  made ;  and  while  they  must  be 
handled  with  great  care,  especially  because  of  dill'erences  in  age,  the 
following  may  be  said  to  display  roughly  the  variations  in  death 
rate  among  social  classes. 

Death  rate  of  males  per  1,000,  according  to  occupations,  for  registration  States, 

1900J> 

Mercantile   and   trading 12. 1 

Clerical    and    official 13.5 

Professional  15.  3 

Laboring  and  servant 20.2 

Special  industries  have  high  death  rates  from  special  diseases. 
Among  dusty  trades,  for  instance,  tuberculosis  is  very  common.*' 

Finally,  the  experience  of  industrial  life-insurance  companies, 
which  deal  largely  with  the  poorer  classes  of  society,  shows  a  higher 
death  rate  than  that  displayed  by  the  experience  tables  of  other  in- 
surance companies.'^ 

Insurance  mortality  per  1,000. 


Ag. 

Ordinary 
insurance, 

English 
experience. 

Industrial 
insurance, 
Metropoli- 
tan Life. 

20 

7.3 

7.8 

9.3 

21.7 

64.9 

10.5 

25              

14.1 

35 

17.2 

65               

35.2 

70 

91.0 

We  find  also  great  variations  in  death  rates  dependent  on  varying 
climatic  or  seasonal  conditions,  on  the  prevalence  or  absence  of  certain 
pests,  on  the  fluctuating  virulence  of  specific  diseases,  and  on  numer- 
ous natural  differences.  Other  significant  factors  in  mortality  are 
historical  events,  such  as  wars,  plagues,  and  ej^idemics.  Hard  times 
bring  increased  mortality,  whether  due  t(^  natural  or  politico-economic 
causes.  There  remain  to  be  mentioned  also  deaths  by  accident  in  all 
its  many  forms. 

"  I.  M.  Rubinow,  "  Poverty's  Death  Rate,"  publications  of  the  American  Sta- 
tist ical  Association,  December,  1905,  p.  348. 

&  "  Twelfth  Census  of  the  United  States,"  Vol.  Ill,  p.  cclxi. 

"  See  Fredoi'iok  L.  Hoffman,  "  Mortality  from  Consumption  in  dusty  trades," 
Bulletin  No.  79  of  the  U.  S.  Bureau  of  Labor. 

<*  Haley  Fiske,  "Industrial  Insurance,"  The  Charities  Review,  March  1S9S,  p.  33. 


646  EEPOET   OF   NATIONAIi  CONSEEVATIOiir   COMMISSION. 

Section  5 — Mortality  historically. 

Not  only  does  the  death  rate  vary  greatly  from  place  to  place  and 
from  one  social  class  to  another,  but  it  changes  in  a  most  marked 
fashion  from  period  to  period  in  history.  The  records  of  old  cities 
show  that  a  decided  decrease  in  mortality  has  been  steadily  going  on. 
In  London,  for  example,  the  rate  per  1,000  has  fallen  from  50  in  1660- 
1679  to  15  in  1905,  a  decrease  of  70  per  cent.  In  the  plague  years,, 
1593, 1625,  1636,  and  1665,  the  death  rates  per  1,000  were  240,  310, 130, 
and  430.«  The  "  black  death  "  in  1348-9  probably  swept  away  half 
of  the  population  in  many  localities  throughout  Europe.' 

Mortality  in  London.'^ 


Year. 

Rate  per 
1.000. 

1660-1679 

60 

1680-1728  6 

80 

1729-1780 

40 

1905 

15.1 

•  Kober,   loc.  cit.,  p.  25. 

*  These   years   include   the   period   of   pests. 

Within  a  quarter  century  London  has  cut  her  death  rate  in  half, 
wliile  Vienna,  if  we  may  trust  the  figures,  has  within  a  century  re- 
duced her  rate  from  60  per  1,000  of  population  to  23."  Similarly,  the 
mortality  rate  in  Boston  has  been  lowered  from  an  estimated  34  per 
1,000  <*  in  1700  to  19  to-day. 

Mr.  John  K,  Gore,  actuary  of  the  Prudential  Insurance  Company, 
shows  ®  that  the  average  death  rates  per  1,000  of  population  among 
typical  American  cities  was,  for  the  white  population,  as  follows: 

Years.  Death   rate   per   1,000. 

1804r-1825 24.  6 

182&-1850 25.  7 

1851-1S63 28.3 

1864-1875  — 1 25.  4 

1876-1888 22.  9 

1889-1901 21.0 

The  record  even  of  the  last  thirty  years  displays  a  fall  in  death 
rates  that  may  inspire  us  with  buoyant  hope  for  the  future.  The 
mortality  rate  per  1,000  has  fallen  in  Berlin  from  33  in  1875  to  16 
in  1904;  in  Munich,  from  41  in  1871  to  18  in  1906;  and  in  Washing- 
ton, from  28  in  1875  to  19  in  1907.^ 

Between  1890  and  1906  New  York  lowered  her  death  rate  per  1,000 
from  25.4  to  18.6,  and  Boston  from  23.4  to  18.9.  The  mortality  rate 
in  the  whole  registration  area  of  the  United  States  fell  from  19.6 
per  1,000  in  1890  to  16.1  in  1906,  although  the  area  in  the  last-named 
year  included  a  larger  proportion  of  urban  population. 

o  See  Farr,  Vital  Statistics,  Loudon,  1885,  p.  131. 

'See  Abbot  Gasquet,  "The  Black  Death  of  1348  and  1349,"  London  (Bell), 
1893. 

"A.  F.  Weber,  "  The  Growth  of  Cities,"  New  York,  1899,  pp.  355,  356. 

*  Shattuck,  loc.  cit.,  pp.  xii-xiv. 

« "  On  the  Improvement  in  Longevity  in  the  United  States  during  the  Nine- 
teenth Century." 

f  Kober,  loc.  cit.,  p.  25. 


FISHIB.1  NATIONAL   VITALITY.  647 

We  have  also  vital  records  for  the  city  of  Habana.  running  back 
over  a  century.  These  show  that  while  the  death  rate  in  1802  was 
given  as  54.6  per  1,000,  rising  in  cholera  years  even  as  high  as  103.4 
(1833)  and  in  the  last  year  of  "Woyler's  concentration  methods  as 
high  as  91,  the  rate  during  the  eight  years  from  1899-190G  ranged 
from  20.4  to  aS.G.* 

These  records  also  show  the  remarkable  and  sudden  fall  that  may 
lie  brought  about  by  a  change  in  the  living  conditions  of  a  community. 
During^  the  three  "concentration"  years  of  1896,  1897,  and  1898 
tlie  mortality  rate  per  1,000  was  51.7,  78.7,  and  91,  respectively.  In 
1JS99,  the  first  complete  year  of  American  occupation,  the  rate 
dropped  to  33.6,  and  since  then  it  has  ranged  between  20.4  and  24.4, 
There  can  be  no  question  that  the  improvement  was  almost  wholly 
due  to  the  sanitary  reforms  introduced  by  Colonel  Gorgas,  and  the 
other  United  States  Army  surgeons  under  Gen.  Leonard  Wood. 

The  record  of  American  Army  sanitarians  in  the  Panama  Canal 
Zone  shows  as  striking  results  as  in  Cuba.  The  death  rate  in 
Panama  during  1887,  when  the  French  canal  companies  held  occu- 
pation, ran  over  100  per  1,000.  In  1906  the  death  rate  was  49  per 
1.000,  while  in  1907  it  fell  to  less  than  34.  Colonel  Gorgas  attributes 
the  decrease  in  the  general  death  rate  in  great  part  to  improved  sani- 
tation, though  he  adds  that  "  increased  wages,  better  food,  and  better 
clothing  have  no  doubt  played  a  considerable  part  in  the  general  im- 
provement of  the  health."  * 

Section  6. — Adult  and  infant  mortality. 

Mortality  varies  greatly  with  age.  The  improvement  in  the  city 
death  rate  of  the  past  half  century  has  been  especially  marked 
among  the  young. 

It  is  true  that  in  countries  of  the  same  degree  of  civilization  the 
infant  death  rate  is  remarkably  constant,*^  but  this  is  probably  ac- 
counted for  by  the  similarity  in  the  methods  of  feeding  of  infants. 
Certainly  where  there  is  a  difference  in  conditions  there  will  be 
found  a  difference  in  mortality.  Thus,  the  comparison  between  the 
mortality  of  infants  fed  on  cow's  milk  and  those  fed  on  mother's 
milk  shows  that  the  former  is  five  to  ten  times  that  of  the  latter.'* 

Although  the  infant  mortality  rate  is  probably  falling,*  the  de- 
crease is  not  accompanied  by  a  lowering  of  the  mortality  of  later 
life.  There  is  an  increased  mortality  beyond  the  age  of  50  years. 
In  Massachusetts  the  death  rates  by  age  changed  during  thirty  years 
as  follows: 

"  "  Report  of  the  National  Sanitary  Department  of  tho  Republic  of  Cuba," 
Habana,  1906,  p.  78. 

*  Letter  from  Col.  W.  C.  Gorfjas,  chief  sanitary  ofl3cer,  Canal  Zone. 

f^  See  E.  B.  Phelps.  "A  Statistical  Study  of  Infant  Mortality,"  quarterly  pub- 
lication of  the  American  Statistical  Association,  September,  1908.  Mr.  Phelps 
Bhows  the  utter  unreliahilify  of  most  statistics  of  infants  under  1  year  of  age, 
especially  in  the  United  States. 

'^  See  Harald  Westergaard.  "  Mortalitilt  und  Morbilitat,"  Jena,  1901,  p.  364. 

®  Edward  E.  Graham,  M.  D.,  "  Journal  of  the  American  Medical  Association," 
September  26,  1908 ;  also  "  British  Medical  Journal,"  February  1^  1908,  p.  271. 


648  EEPORT   OF   NATIONAL,   CONSERVATION   COMMISSION. 

Death  rate  m  Massachusetts  per  1,000  of  population  in  each  age  period.'^ 


Age. 

1865. 

1895. 

5-9 

9.6 
5.1 
9.« 

12.6 

11.7 

12 

17 

33 

70 
168 

6  2 

10-14 

3.2 

15-19 

5  3 

20-29 

7.1 

.30-39 

9  7 

40-49 

13 

50-59 

20 

60-69 

39 

70-79 

82 

80  and  upward 

185 

»  "  Vital  Statistics  of  Massachusetts,"   1856-1895,  p.  755. 

*  Here,  while  the  death  rate  for  all  age  periods  under  40  has  mate- 
rially decreased,  the  later  periods  of  life  have  suifered  progressive 
increases  in  mortality  rate." 
As  Frederick  L.  Hoffman  has  expressed  it : 

There  is,  of  course,  no  question  whatever  that  the  American  death  rate,  using 
the  term  in  a  very  comprehensive  sense,  has  substantially  declined  within  the 
last  fifty  years,  but  it  is  equally  evident  that  this  decline  has  been  at  the  younger 
ages,  and  not  during  the  period  of  life  which,  economically,  is  of  the  gi'eatest 
value.  There  is  no  doubt  that  the  mortality  of  adult  ages  is  still  decidedly 
excessive. 

The  same  tendency,  viewed  from  the  standpoint  of  the  exjoectation 
of  life,*  is  disclosed  in  the  study  of  two  Massachusetts  life  tables, 
compiled  nearly  a  century  apart — one,  Wigglesworth's  life  tables  for 
Massachusetts  and  New  Hampshire  in  1789,  though  not  very  accurate ; 
the  other,  Abbott's  Massachusetts  life  tables  for  1893-1897. 

Expectation  of  life  in  Massachusetts. 


Age. 

1789. 

1897. 

Age. 

1789. 

1897. 

0 

35.5 
43.2 
34.2 
26 

45.4 
50 
42 
28.2 

60.       . . . 

15.4 
5.9 
3.7 

15  1 

10 

80 

6  1 

20 

90  . 

3  i 

40 

These  figures  indicate  that  the  expectation  of  life  at  the  earlier 
ages  is  much  greater  than  a  century  ago,  but  that  for  the  age  of  60 
and  upward  it  has  remained  practically  stationary. 

"At  first  sight  it  would  seem  that  this  increased  mortality  in  later  ages  could 
be  explained  away  as  due  to  the  larger  number  of  persons  who  are  saved  from 
earlier  death  and  tend  to  produce  a  higher  mortality  at  the  older  ages.  I  speak 
of  this  because  very  intelligent  persons  have  drawn  this  conclusion.  But  it  is 
obviously  fallacious,  since  the  figures  do  not  indicate  the  number  of  deaths  in 
different  periods,  but  the  death  rates  in  dift'erent  periods  of  life  per  1,000  at  each 
period.  There  are,  to  be  sure,  as  a  consequence  of  saving  lives  in  the  past, 
more  old  men  now  living  than  otherwise  there  would  be,  and  there  will  be  more 
deaths,  but  the  figures  show  that  these  old  deaths 'have  increased  faster  than 
the  number  of  old  men.  This  fact  raises  the  suspicion,  therefore,  that  the 
lives  which  have  been  saved  by  the  hygiene  of  a  generation  ago  are  weak  lives, 
Whether  this  is  a  tenable  hypothesis  or  not  will  be  discussed  in  Chapter  X. 

*  "  Expectation  of  life  "  at  any  given  age  is  the  mean  after-lifetime  of  per- 
sons who  reach  that  age.  Thus  100  persons  have  an  expectation  of  life  of  50 
at  the  age  of  10,  if  the  total  life  to  be  lived  by  those  100  persons  before  death 
1«  five  thousand  years. 


wisma  1 


NATIONAL   VITALITY. 


649 


English  life  tables "  for  three  decades  ending  1900  display  the  same 
tendency. 

English  life  tables — Expectation  of  life. 


MALES. 


Age. 

1871-18S0. 

1881-1890. 

1891-1900. 

0 

41.4 

39.4 

13.1 

4.8 

43.7 

40.3 

12.9 

4.5 

44.1 

20 

41 

60 

12.0 

80 

4.0 

FEMALES. 

0 

44.6 

41.7 

14.2 

5.2 

47.2 

42.4 

14.1 

6 

47.8 

20 

43.4 

60 

14.1 

80 

5.1 

These  tables  show  that  there  is  improvement  at  the  younger  ages 
for  the  period  1891-1900  over  the  period  1871-1880.  For  ages  over 
60  there  has  been  a  retrogression.  It  is  observable,  however,  that 
between  the  periods  1881-1890  and  1891-1900  the  figures  for  60  years 
have  remained  stationary,  and  for  80  have  slightly  improved. 

In  other  words,  a  baby  to-day  has  in  prospect  a  much  longer 
average  lifetime  than  did  the  baby  of  two  generations  ago;  but  a 
man  or  woman  60  years  old  has  in  prospect  an  average  after  lifetime 
no  greater  than  formerly. 

The  proximate  cause  of  this  contrast  would  seem  to  lie  in  the  fact 
that  the  mortality  from  many  of  the  diseases  of  later  life  has  been 
and  is  on  the  increase.  The  death  rates  from  diabetes,  heart  disease, 
and  Bright's  disease  have  all  doubled  in  thirty  years.' 

Cancer  is  probably  on  the  increase,"  and  "  to-day  one  in  every  21 
men  who  have  reached  the  age  of  35  and  one  in  every  12  women  who 
have  reached  35  eventually  die  of  that  disease."  "^ 

In  addition,  there  may  be  mentioned  other  diseases,  arteriosclerosis, 
nephritis,  apoplexy,  paresis,  disorders  of  the  liver,  and  all  manner  of 
degeneration,  all  of  them  maladies  of  adult  life,  and  all  of  them 
apparently  tending  to  increase. 

Section  7. — Particular  diseases. 

We  turn  now  to  the  ravages  made  by  particular  diseases  in  the 
modern  world.  The  death  rate  in  the  United  States  from  tuber- 
culosis of  all  forms  equals  the  combined  death  rate  from  small- 
pox, typhoid  fever,  diphtheria,  cancer,  diabetes,  appendicitis,  and 

meningitis. 

"  "  Supplement  to  Sixty-fifth  Annual  Report  Register-General  of  England  and 
Wales,"  pt.  1,  1907,  p.  XLVIII-LI. 

^  Xorman  E.  Dilman,  M.  D.,  "  Education  and  its  Economic  Value  in  the  Field 
of  Preventive  Medicine,"  Columbia  University  Quarterly,  Supplement  to  June, 
1908,  p.  38. 

■  cElie  Metchnikoff,  "The  Nature  of  Man,"  English  translation,  New  York 
(Putnam),  1903,  pp.  213,  214;  see  also  "United  States  Census  mortality  statis- 
tics, 1906,"  p.  29. 

'  Ditman,   loc.   cit,   p.   38. 


650  REPORT  OF    NATIONAL    CONSERVATION    COMMISSION. 

The  death  rate  from  tuberculosis  of  all  kinds  in  the  registration 
area  was  183.6  per  100,000  in  1907."  The  rate  is  high  among  negroes.* 
Large  as  these  figures  are,  they  represent  a  considerable  decrease 
since  1900."    Tuberculosis  is  a  preventable  disease. 

On  a  par  with  tuberculosis  in  the  number  of  its  victims  in  this, 
country  stands  pneumonia. 

The  mortality  statistics  of  the  last  census  show  that  in  the  registra- 
tion area  of  the  United  States  pneumonia  is  responsible  for  11  per 
cent  of  all  deaths.  Pneumonia  is  now  known  to  be  a  communicable 
disease,  the  germ  of  which  is  very  widely  distributed;  but  there  is 
great  need  for  sj^ecial  researches  into  the  modes  of  spreading  this 
formidable  disease.  In  the  meantime  the  best  protection  is  to  "  keep 
in  condition."  While  the  germ  of  pneumonia  is  the  exciting  cause  of 
the  disease,  predisposing  causes  are  acute  or  chronic  alcoholism,  ex- 
posure to  cold,  extreme  exhaustion,  and  debility  of  any  kind. 

Typhoid  fever  is  in  some  places  yielding  to  preventive  measures  in 
a  most  striking  manner.  The  fall  in  the  death  rate  from  typhoid  in 
the  registration  area  from  4G.3  per  100,000  of  population  in  1890  to 
33.9  in  1900,'*  and  to  32.1  in  1906,*  may  be  safely  ascribed  to  improve- 
ments in  the  water  and  milk  supplies  of  our  cities.  The  surprising 
reduction  of  the  typhoid-fever  death  rate  in  individual  cities,  result- 
ing from  definite  improvements  in  the  water  supply,  gives  direct  con- 
firmation of  this  statement. 

The  typhoid  mortality  in  Munich  during  1856  was  291  per  100,000 
of  population.  The  city  at  that  time  contained  numerous  cesspools, 
and  the  water  supply  was  largely  obtained  from  wells  and  pumps. 
From  1856  to  1887  there  was  great  activity  in  the  filling  up  of  cess- 
pools, the  abandonment  of  pumps  and  wells,  and  the  installation  of 
modern  sewers.  A  pure  water  supply  was  also  secured,  the  water 
being  brought  from  a  distance.  The  typhoid-fever  death  rate  fell  in 
1887  to  10  per  100,000  of  population — a  reduction  of  97  per  cent.' 

In  Hamburg  the  typhoid  mortalitv  for  1880-1892  ranged  from  24  to 
88,  averaging  39.7  per  100.000.     In  May,  1893,  a  filtration  plant  was . 
opened,  and  the  rate  fell  in  that  same  year  to  18.     For  the  five  years 
following  it  averaged  only  7.2,  showing  a  reduction  of  over  80  per 
cent.^ 

The  introduction  of  a  water  filter  in  the  town  of  Lawrence,  Mass., 
in  1893  was  followed  by  a  reduction  in  deaths  caused  by  typhoid  . 
from  105  in  1892  to  22  in  1896,  one-fifth  the  previous  figure.     Filter- 

"  For  a  careful  statistical  study  of  tuberculosis  see  "Tuberculosis  iu  tlie 
United  States,"  United  States  Census,  issued  for  the  International  Congress  on 
Tuberculosis,  190S.  See  also  "  Bulstrode's  Report  in  Tliirty-flfth  Annual  Report 
of  (Euglisli)  Local  Government  Board,  1905-6,"  and  Arthur  Newsholme,  M.  D., 
"  Prevention  of  Tuberculosis,"  1908. 

^  For  the  prevalence  of  tuberculosis  in  the  negro,  see  F.  L.  Hoffman's  valuable 
monograph,  "  The  American  Negro,"  publications  of  the  American  Economic 
Association,  August,  1S96. 

"  This  decrease  is  shown  by  the  exact  figures  (not  estimated)  in  the  registra- 
tion area. 

<*  Twelfth  Census  of  the  United  States,  Vol.  Ill,  p.  cxliv. 

«  Mortality  Statistics,  U.  S.  Census  Office,  1906,  p.  30. 

f  Ditman,  loc.  cit.  p.  17. 

s  A.  C.  Abbott,  IM.  D.,  "  The  Hygiene  of  Transmissible  Diseases,"  Philadelphia, 
Saunders,  1899,  pp.  88-89. 


"«HEE.]  NATIONAL  VITALITY.  651 

ing  the  city  water  in  several  other  American  cities  has  shown  abrupt 
ieclines  in  the  typhoid  death  rate  almost  as  remarkable." 

Another  method  of  pointing  out  the  importance  of  a  pure  water 
supply  is  to  compare  the  mortality  rates  from  typhoid  fover  of  cities 
bhat  secure  water  from  various  sources  of  supply,  as  the  following 
;able  shows : " 

Death  rate  from  typhoid  fever  per  100,000  of  population,  1902-1906. 

4  cities  using  ground  water  from  large  wells 18.1 

v8  cities  using  impounded  and  conserved  rivers  or  streams 18.  5 

8  cities  using  water  from  small  lakes 19.3 

7  cities  using  water  from  Great  Lakes 32.8 

5  cities  using  surface  and  underground  water 45.7 

.9  cities  using  polluted  river  water 61. 1 

Thus  far  our  studies  indicate  that  typhoid  fever  will  cease  to  be  a  "  prob- 
em  "  in  any  community  having  clean  water  and  an  uninfected  milk  supply,  and 
ji  which  cases  of  the  disease  are  treated  as  dangerous  and  conta&ious."  « 

Unfortunately  such  communities  are  too  rare  at  present. 

Perhaps  the  most  common  and  neglected  source  of  danger  of  in- 
fection from  typhoid  is  the  ordinary  house  fly  or,  as  Dr.  L.  O.  How- 
ird,  chief  of  U.  S.  Bureau  of  Entomology,  would  have  us  call  it, 
,he  "  typhoid  fly." 

Smallpox,  another  disease  that  yields  readily  to  preventive  meas- 
ires,  has  decreased  greatly  in  virulence  and  mortality  since  the 
ntroduction  of  vaccination.  In  Prussia,  for  example,  the  death 
*ate  from  smallpox  per  100,000  population  was  24.4  in  the  period 
Tom  1846-1870.  In  1874  vaccination,  which  up  to  that  time  had 
)een  onlv  intermittently  utilized,  was  made  compulsory,  and  the 
ieath  rate  per  100,000  fell  at  once  to  1.5  for  the  years  1875-1886.'' 

Other  European  States,  however,  have  been  more  lax  than  Ger- 
nany.  In  1886  the  death  rate  from  smallpox  in  Switzerland  was 
ifty-fourfold  that  of  Germany;  in  Belgium,  forty-eightfold;  in 
iustria,  eighty-onefold,  and  in  Hungary,  six  hundred  and  sevenfold." 

Babbage  '"  states  that  "  it  has  been  shown  by  M.  Duvillard  that  the 
ntroduction  of  vaccination  has  increased  the  mean  duration  of  human 
ife  about  three  years  and  a  half."  Before  Jenner's  utilization  of 
vaccination  to  guard  against  smallpox  that  disease  was  causing  one- 
^nth"  of  all  deaths  of  the  human  race,  just  as  does  tuberculosis 
o-day,  while  "  nearly  twice  as  many  were  permanently  disfigured  by 
ts  ravages.  In  England  300  per  100,000  population  died  annually 
Tom  it.  It  is  computed  that  during  the  eighteenth  century  50,000,000 
)eople  died  of  smallpox  in  Europe." '' 

<*  8ee  Kuber,  loc.  cit.,  pp.  IS,  lU. 
*Kober,  loc.  cit,  p.  15. 

•  M.  J.  Rosenau,  L.  L.  Lumsden,  and  Jos.  H.  Kastle,  "  The  origin  and  prev- 
lence  of  typhoid  fever  in  the  District  of  Columbia,"  Hygienic  Laboratory 
iulletin  No.  44,  190S,  p.  9. 

^  Ditman,  loc.  cit.,  p.  8. 

^  Floyd  M.   Crandall,   "A  century  of  vaccination,"  American   Medicine,   De- 
ember  7,  1901. 
'  Loc.  cit,  p.  8.  " 

"  Crandall,  loc.  cit,  p.  6. 

*  Ditman,  loc.  cit,  pp.  6,  52-3. 

S.  Doc.  419,  Gl-2 3 


652  REPORT   OF   NATIONAL  CONSERVATION    COMMISSION. 

Boston  was  visited  twelve  times  by  smallpox  epidemics  in  tlie  cen- 
tury and  a  half  ending  1800." 

Yet  where  vaccination  has  been  made  compulsory,  or  where  it  is 
generally  resorted  to,  smallpox  has  virtually  disappeared.  The  last 
census  reported  but  3,500  deaths  from  smallpox  in  the  United  States 
in  1900.  Even  as  long  ago  as  1826  Denmark  was  enforcing  the  prac- 
tice of  vaccination  so  vigorously  that  not  a  single  case  had  appeared 
for  eleven  years.''  Habana,  during  the  eight  years  prior  to  the  Amer- 
ican intervention,  reported  3,132  deaths  from  smallpox.  In  1899 
the  year  following  the  American  entry,  there  were  four  deaths,  and 
three  more  during  the  next  seven  years — a  virtual  uprooting  of  the; 
disease.*' 

The  present  outcry  against  vaccination  is  based  on  a  misunder- 
standing, and  is  one  of  many  evidences  of  the  imperative  necessity 
of  the  diffusion  of  correct  knowledge  among  the  people  on  matters 
of  hygiene  and  preventive  medicine.  Whether  vaccination  should  be 
made  compulsory  is  a  fair  question,  but  that  it  is  efficacious  is  not 
open  to  question.  The  argument  that  because  some  unvaccinated 
persons  escape  during  an  epidemic  all  would  escape  is  too  absurd 
to  deserve  serious  consideration."* 

Yellow  fever  first  appeared  in  serious  form  at  Philadelphia  inl 
1793,  when  one-tenth  of  that  city's  population  died  of  it  in  the  space 
of  six  and  a  half  weeks.  Since  1793  the  United  States  has  had  500,- 
000  cases,  resulting,  it  is  estimated,  in  about  100,000  deaths.  In 
1900  it  was  discovered  that  a  species  of  mosquito  is  responsible  for 
the  transmission  of  this  fever,  and  in  consequence  of  this  knowledge 
and  its  application  the  disease  is  now  practically  banished  from  thi^ 
country.* 

The  marked  decrease  in  the  death  rate  from  yellow  fever  in  Ha- 
bana since  the  American  intervention  in  1898  is  shown  in  the  fol- 
lowing table.  The  deaths  from  yellow  fever  numbered  4,420  in  the 
eight  years  from  1891  to  1898,  while  in  the  eight  years  from  189J 
to  1906  they  numbered  but  465. 

»  Shattuck,  loc.  cit,  p.  xiv. 

'  Crandall.  op.  cit. 

"  Report  of  National  Sanitary  Department  of  the  Republic  of  Cuba,  Habana 
1906,  p.  79. 

<*  For  the  most  scientific  statistical  studies  of  vaccination  see  W.  R.  Mac 
donnell,  Biometrika,  Vol.  I,  1902,  p.  375,  and  Vol.  II,  1903,  p.  135.  J.  Brown, 
lee,  Biometrika,  Vol.  IV,  1905-6,  p.  313.  F.  M.  Turner,  Biometrika,  Vol.  IV 
p.  483.  Karl  Pearson,  Biometrika,  Vol.  IV,  and  Philosophical  Transactions  o1 
the  Royal  Society  of  London,  Series  A,  Vol.  195,  p.  43.  Humphreys,  Journal  oJ 
the  Royal  Statistical  Society,  1897,  p.  503.  For  the  best  of  antivaccination  lit! 
erature  see  Alfred  Russell  Wallace,  "  The  Vaccination  Delusion,"  and  MilneS 
Journal  Royal  Statistical  Society,  1897,  p.  5-52  (Comment  by  G.  U.  Yale,  p.  608); 
For  both  sides  see  Report  of  the  Royal  Commission  on  Vaccination,  1897. 

*  Ditman,  loc.  cit,  pp.  11-12. 


yiBHXB.] 


NATIONAL.  VITALITY. 


658 


Yellow-fever  death  rate  in  Haharva,  1870-1906. 
[Rate  per  100,000  population."] 


Before  American  Intervention. 

.vrter  American  Int 

erventlon. 

1S70. 

300  5 

1898.... 

1899.... 
1900.... 
1901 

67  8 

1880... 
1890. . . 
1895... 

..  32'1.5 

..  15;!.  (i 

.  27.5.  S 

.  6;i<j.5 

..  428 

...     42.5 

...  124.0 

6.9 

1896... 

1902 

0 

1887... 

1903.... 
1904.... 
1906.... 
1906. . . . 

...      0 
...       0 
. . .       8.  0 
...       4.3 

"Report  of  the  National  Sanitary  Department  of  the  Republic  of  Cuba,  1906,  p.  79. 

These  results  have  been  due  partly  to  the  elimination  of  the 
contagion-carrying  mosquito  and  partly  to  the  general  improvement 
of  the  city's  sanitary  appointments. 

A  similar  contrast  might  be  drawn  between  the  death  rates  from 
yellow  fever  at  Panama  during  the  efforts  of  the  French  to  dig  the 
canal  and  during  the  American  work  under  the  sanitary  regulations 
of  Colonel  Gorgas.  If  the  same  thoroughgoing  measures  used  in 
Habana  and  at  Panama  were  employed  among  our  own  people,  the 
resultant  blessings  would  be  almost  equally  striking. 

The  impressive  figures  just  presented,  showing  the  fall  in  mortality 
from  so  many  of  the  most  dangerous  diseases,  point  clearly  to  the 
value  of  preventive  measures  in  the  conflict  with  disease.  The  fall 
in  tuberculosis  mortality  is  directly  due  to  the  growing  use  of  hospi- 
tals, which  have  tended  to  isolate  '*  consumptives,  and  to  a  use  of  our 
recently  acquired  knowledge  of  the  efficacy  of  fresh  air  and  the  out- 
door life;  typhoid  fever  has  virtually  disappeared  when  water  and 
milk  supplies  have  been  made  pure,  the  open  privy  abolished,  and 
flies  and  other  carriers  of  the  specific  cause  of  the  disease  have  been 
provided  against ;  smallpox  has  given  way  before  vaccination ;  yellow 
lever  is  fast  disappearing  now  that  the  agent  of  transmission  is 
known ;  while  many  of  the  less  serious  diseases  are  losing  their  power, 
purely  owing  to  preventive  methods. 

Some  diseases,  once  the  scourges  of  humanity,  have  practically 
disappeared  from  the  civilized  world. 

Scurvy  up  to  the  latter  half  of  the  eighteenth  century  decimated 
the  armies  and  fleets  of  Europe  and  afterwards  proved  a  menace  to 
the  civilized  population.  During  Anson's  famous  expedition  about 
the  year  1750,  600  out  of  900  died,  chiefly  from  scurvy.  The  use  of 
lime  juice  and  fresh  vegetables  has  practically  eradicated  the  disease,^ 

"  Cholera  was  wont  to  visit  the  cities  of  the  Atlantic  coast  in  the 
past  about  every  ten  years,  and  it  was  a  standing  menace  to  the  world 
every  summer.  It  was  not  uncommon  for  the  disease  to  decimate 
whole  towns  and  cities.  Since  the  discovery  of  its  cause,  however,  it 
has  been  robbed  of  its  terrors,  and  the  children  of  to-day  will  prob- 
ably never  know  of  it  except  by  name." 

Malaria  has  been  on  the  decrease  ever  since  the  discovery  that  the 
malarial  organism  is  transported  by  a  species  of  mosquito.     Even  the 

<»  See  Arthur  Newsholme,  "  Tlie  phthisic  death  rate,"  Journal  of  Hygiene, 
July,  1906. 

'  Ditman,  loc.  cit,  14-15. 


654 


EEPOET   OF   NATIONAL   CONSERVATION   COMMISSION. 


five  years  ending  1906  show  a  progressive  decline  in  the  death  rate 
from  malarial  fever  in  tlie  registration  area.  The  figures  are  5.4,  4.3, 
4.2,  3.9,  and  3.5  deaths  per  100,000  of  population,  for  the  five  years  in 
question.  In  themselves,  the  figures  are  so  small  as  to  show  the  virtual 
disappearance  of  the  disease,  at  least  from  the  Northern  States.  It 
is  still  very  common  in  the  Southern  States.  Its  evil  is  by  no  means 
to  be  measured  by  the  deaths  it  causes.  It  produces  chronic  disability 
and  predisposes  to  other  diseases." 

Finally,  the  furnishing  of  pure  milk  to  the  infant  population  of  the 
cities  is  eliminating  year  by  year  the  infant  scourges — diarrheal  dis- 
eases and  related  maladies. 

There  are  of  course  diseases  which  show  no  sign  as  yet  of  decreas- 
ing. The  census  volume,  "Mortality  Statistics  of  1906"  (p.  29) 
gives  only  one  important  disease  (diabetes)  as  actually  on  the  increase 
within  the  registration  area,  but  several  which  are  given  as  having 
"  fluctuating  rates,"  such  as  cancer,  heart  disease,  and  Bright's  disease, 
seem  still  to  have  an  upward  trend. 

It  is  known  that  malaria  is  preventable.  Why,  then,  is  it  not  pre- 
vented in  the  South?  Probably  for  two  reasons.  First,  the  facts  are 
not  generally  known,  owing  to  lack  of  vital  statistics  in  the  Southern 
States.  Second,  owing  largely  to  this  ignorance  no  adequate  effort 
has  yet  been  made.  A.s  an  example  of  what  can  be  done  we  have  the  i 
cleaning  of  Habana  by  Colonel  Gorgas.  The  following  table,  sup- 
plied by  him,  shows  the  deaths  from  malaria  from  1899  to  1907 : 


Year. 

Number 

of 
deaths. 

Year. 

Number 

of 
deaths. 

1899               

909 

325 

151 

77 

61 

1904 

44 

]900                               

1905 

32 

1901                   

1906 

26 

1902                                   

1907 

o23 

1903                 

»  Annual  Report  of  the  Sanitary  Department  for  the  City  of  Habana  for  the  year  1907. 

"  The  first  year  quoted,  1899,  the  malarial  deaths  were  excessive, 
owing  to  the  crowding  into  the  city  of  the  '  reconcentrados '  and  the 
starvation  and  misery  thereby  involved. 

The  next  year,  1900,  was  about  the  normal  rate.  The  next  year, 
1901,  begins  to  show  the  effect  of  the  antimalarial  work  done  in  con- 
nection with  the  yellow-fever  work;  1901  was  the  first  year  of  mos- 
quito work  in  Habana.  The  last  year,  1907,  shows  only  23  deaths 
from  malaria.  This  means  practically  the  extinction  of  malaria  in 
Habana.  The  item  of  23  deaths  in  1907  from  malaria  would  probably 
be  covered  by  the  malarial  cases  coming  in  from  the  rural  districts 
and  by  mistakes  in  diagnosis." 

The  preventability  of  accidents  is  beginning  to  be  appreciated.  It 
is  now  proposed  by  Mr.  W.  H.  Tolman  to  establish  in  New  York  a 
museum  of  safety  and  sanitation  to  demonstrate  this  fact.  Mr. 
Frederick  L.  Hoffman,  statistician  of  the  Prudential  Insurance  Com- 
pany, estimates  the  number  of  deaths  among  male  workers  alone  in 
1908  as  between  30,000  and  35,000." 


<»  See  "  Report  to  the  Conservation  Commission  "  of  L.  O.  Howard.   "  Eco- 
nomic loss  to  the  people  of  the  United  States  through  insects  that  carry  disease." 
<> "  Industrial  accidents,"  Bulletin  of  the  Bureau  of  Labor,  1908. 


Part  II.— THE  BREADTH  OF  LIFE  VERSUS  INVALIDITY. 

Chapter  III. — Prevalence  of  serious  illness. 
Section  1 — Loss  of  time. 

Length  of  life  is  but  one  indication  of  vitality.  Everyone  recog- 
nizes that  the  life  of  a  valetudinarian  or  an  invalid,  however  long,  is 
but  a  narrow  stream.  "We  may  therefore  conceive,  besides  the  dimen- 
sion of  length,  another  dimension  of  life  which  may  be  called  its 
"  breadth."  By  the  breadth  of  life  we  mean  its  healthiness.  Just 
as  length  of  life  is  limited  by  and  opposed  to  mortality  or  death,  so 
breadth  of  life  is  limited  by  and  opposed  to  invalidity  or  illness. 

An  ideally  healthy  life,  free  throughout  from  ailment  and  dis- 
ability, is  rarely  if  ever  found.  But  it  is  the  aim  of  hygiene  to  ap- 
proximate such  an  ideal.  Some  persons  imagine  that  length  of  life 
can  be  jiurchased  only  at  the  expense  of  breadth,  and  counsel  the 
deliberate  shortening  of  one's  life  for  the  sake  of  living  it  faster.  In 
exceptional  cases  such  a  policy  may  be  justified,  but  the  study  of 
longevity  reveals  the  fact  that,  as  a  rule,  length  and  breadth  of  life 
are  not  opposed,  but  that,  on  the  contrary,  the  one  can  seldom  be 
increased  without  an  increase  of  the  other.  Centenarians  are  usually 
persons  who  have  been  exceptionally  free  from  illness"  and  who 
have  performed  a  large  amount  of  work.  This  work  is  usually 
physical  labor  out  of  doors,  although  the  few  mental  workers  com- 
pleting the  century  have  also  lived  busy  lives. 

Chevreul,  the  distinguished  French  chemist  who  died  twenty  years 
ago  at  the  age  of  103,  lived  a  life  of  great  activity  and  usefulness  as 
laboratory  experimenter,  as  industrial  chemist,  as  university  pro- 
fessor, and  as  a  writer  and  lecturer.  It  was  said  of  Alexander  Von 
Humboldt,  who  was  90  at  the  time  of  his  death,  that  he  had  not  only 
lived  twice  as  long  as  others  in  years,  but  that  in  work  accomplished 
he  had  lived  twice  as  much  per  day,  thus  enjoying  four  times  the 
average  lifetime. 

It  is  shortsighted  to  spend  more  vitality  each  day  than  we  earn. 
Such  a  policy  must  not  only  prove  suicidal  sooner  or  later,  but  tends 
to  narrow  one's  life  in  every  way  long  before  the  arrival  of  death. 
The  ordinary  individual  burns  the  candle  at  both  ends.  The  result 
is  an  almost  universal  invalidism  in  some  degree.  "VVliile  statistics 
are  lacking,  a  wide  observation  seems  to  justify  the  conclusion  that 
it  is  difficult  to  find  a  man  or  woman  over  40  whose  health  has  not 
become  impaired  in  some  manner.  Few  who  have  not  studied  the 
facts  realize  how  common  illness  is,  although  we  all  know  it  is  suf- 
ficiently common  to  make  the  question  "  How  are  you?"  the  ordinary 
form  of  salutation. 

•  Metchnikoff.  "  The  Prolongation  of  Life,"  English  translation,  New  York, 
(Putnam's)   1908,  p.  145. 

655 


656  BEPOBT   OF   NATIONAL,  OONSEEVATION   COMMISSION. 

Serious  illness  is  such  as  totally  incapacitates  a  person  from  work, 
whether  or  not  h©  is  confined  to  his  bed.  The  burden  of  serious  ill- 
ness is  felt  in  several  distinct  ways.  There  is  the  annual  idleness  en- 
tailed by  this  illness,  the  cost  of  maintaining  institutions  devoted  to 
the  care  of  the  sick,  and  the  cost  to  the  individual  of  medicines,  medi- 
cal service,  and  nursing. 

The  amount  of  invalidity  or  illness  in  a  community  has  been  esti- 
mated by  a  number  of  different  investigators,  and  in  a  number  of  dif-i 
ferent  ways.  While  the  results  vary  somewhat,  on  the  whole  they 
harmonize  fairly  well." 

The  most  careful  consideration  of  the  various  illness  statistics  avail- 
able was  made  by  FaiT.  He  finds  that  the  rate  of  invalidity  increases 
with  age,  and  at  the  later  ages  increases  with  great  rapidity.  The 
material  he  has  used  has  come  chiefly  from  various  friendly  societies 
in  Great  Britain  and  Scotland,  and  especially  from  the  East  India 
Company.  His  final  conclusion  is  probably  nearly  as  valid  to-day  as 
then.  It  is  that  corresponding  to  each  death  in  a  community,  there 
are  a  little  more  than  two  years  of  illness. 

Another  way  of  expressing  the  same  fact  is  that  for  each  annual 
death,  there  are  on  the  average  two  persons  constantly  sick  during  the 
year.  Applying  this  estimate  to  the  United  States,''  in  which  about  i 
1 ,500,000  persons  die  per  annum,  there  are  probably  at  all  times  about 
3,000,000  persons  seriously  ill.  This  means  an  average  of  thirteen 
days  per  annum  for  each  inhabitant." 

Returns  gathered  from  79  benefit  societies  in  Scotland,  aggregating 
over  100,000  members,  and  based  on  the  experience  of  various  periods 
between  1750  and  1821,  showed  that  the  average  duration  of  sickness 
for  each  member  under  seventy  years  of  age  was  ten  days  per  year,  2 
of  which  were  assumed  to  be  "  bedfast  "  days,  five  as  days  of  walking 
sickness,  and  three  as  days  of  permanent  sickness.'* 

Section  2 — Particular  diseases. 

It  has  been  estimated  that  the  number  of  persons  in  the  United 
States  constantly  suffering  from  tuberculosis  reaches  500,000.  Of  this 
number  probably  about  half  are  totally  incapacitated,  while  the  re- 
mainder are  able  to  earn  about  half  of  the  ordinary  wages.® 

"  See  Farr,  Vital  Statistics,  London,  18S5,  pp.  501-514.  Ha  raid  Westergaard, 
Mortalitat  und  Morbilitat,  Jena,  1901,  p.  683.  See  also  a  pamphlet  by  Hiram  J. 
Messenger,  actuary  of  the  Travelers'  Insurance  Company,  Hartford  "  The  Rate 
of  Sickness;"  Pettenkofer,  quoted  by  UfEelman,  Handbuch  der  Hygiene,  p.  3. 
Edwin  Chadwick,  "The  Health  of  Nations,"  ed.  by  B.  W.  Richardson,  2  vols. 
(Longmans),  London,  1887,  Vol.  I,  p.  57;  Mayo-Smith,  "  Statistics  and  Sociology," 
New  York,  (Macmillan)  1895,  p.  158;  "  Statistische  Jahrbuch  fCr  das  Deutschen 
Reich,  1908,"  pp.  304-305. 

^  Judging  from  the  experience  of  sickness  insurance,  there  is  more  sickness  in 
the  United  States  than  in  England.  See  Dr.  Edward  Jarvis,  "  Political  Econ- 
omy of  Health,"  Fifth  Report  of  Mass.  Board  of  Health,  1874.  Dr.  Jarvis  also 
points  out  that  estimates  of  illness  are  based  on  experience  of  provident  persons 
among  whom  illness  is  a  minimum,  and  that  the  estimates  of  illness  take  no 
account  of  chronic  ailments  or  "  decrepitude." 

<=  Farr,  Vital  Statistics,  p.  513. 

<»  Edwin  Chadwick,  "The  Health  of  Nations,"  vol.  1,  pp.  56-57. 

« Irving  Fisher,  "  The  Cost  of  Tuberculosis  in  the  United  States  and  Its  Re- 
duction," paper  read  before  International  Congress  on  Tuberculosis,  Washing- 
ton, 1908;  see  also  Huber,  "Consumption  and  Civilization,"  Philadelphia,  1906; 
and  Bardswell,  "  The  Consumptive  Workingman,"  London,  1906. 


W8HEE.]  NATIONAL.  VITALITY.  657 

For  every  death  from  typhoid  fever,  there  are  about  8  cases  of  ill- 
ness, averaging  seventy-five  days  of  incapacity.  But  this  is  not  the 
only  loss.  Professor  Sedgwick  has  said,  "  Hazen's  theorem  asserts  that 
for  every  death  from  typhoid  fever  avoided  by  the  purification  of  a 
polluted  public  water  supply  two  or  three  deaths  are  avoided  from 
other  causes.  Working  under  my  direction  Mr.  Scott  MacNutt  has 
recently  been  able  to  confirm  this  surprising  theorem,  and  even  to 
establish  it  as  conservative.  We  have  also  gone  further  than  Hazen 
and  discovered  what  the  other  causes  are  from  which  deaths  are  thus 
avoided ;  and,  although  our  results  are  not  yet  all  published,  I  may  say 
that  conspicuous  among  these  are  pneumonia,  pulmonary  tuberculosis, 
bronchitis,  and  infant  mortality."  <» 

The  prevalence  of  the  hook-worm  disease  in  the  South  has  been  a 
matter  of  investigation  for  several  years  by  Doctor  Stiles '''  of  the 
Public  Health  and  Marine-Hospital  Service.  The  disease  is  remarka- 
ble not  so  much  for  its  fatality,  though  that  is  large,  as  for  the  chronic 
incapacity  for  work  which  it  produces.  For  this  reason  the  hook 
worm  has  been  nicknamed  the  "  germ  of  laziness."  The  disease  ex- 
tends over  the  whole  South,  and  is  responsible  for  a  large  part  both 
of  the  sickness  (the  so-called  "laziness")  and  of  the  poverty  of  the 
"  whit€  trash." 

There  are  no  satisfactory  statistics  as  to  the  extent  of  hook-worm 
disease;  but  it  has  been  estimated  that  the  sufferers  are  incapacitated 
for  labor  from  one-fourth  to  one-half  of  their  time.  Most  striking  is 
the  fact  that  the  disease  is  easily  preventable  through  the  introduction 
of  sanitary  measures  as  well  as' curable  by  the  proper  (drug)  treat- 
ment of  the  present  victims.  It  has  been  largely  eradicated  from 
Porto  Rico.''  Hook-worm  disease  weakens  when  it  does  not  kill  and 
is  known  to  be  a  precursor  of  tuberculosis. 

Malaria  is  one  of  the  diseases  which  are  fatal  relatively  seldom,  but 
which  shorten  life  by  predisposing  to  other  causes  of  death,  and  nar- 
row life  by  reducing  working  efficiency  by  a  large  percentage.    Doctor 
I  Howard  states  that  each  year  there  are  probably  3,000,000  cases  of 
[  malaria  in  the  United  States,  most  of  which  are  in  the  South.     This 
is  practically  all  preventable.* 

Dr.  Prince  A.  Morrow  says  that  the  number  of  syphilitics  in  the 
^  United  States  has  been  estimated  at  2,000,000.     This  disease  is  not 
only  in  itself  a  danger,  but  it  also  causes  a  large  number  of  diseases 
of  the  circulatory  and  nervous  systems. 

Doctor  Morrow  says  that  the  extermination  of  social  diseases 
would  probably  mean  the  elimination  of  at  least  one-half  of  our  insti- 
tutions for  defectives.  The  loss  of  citizens  to  the  State  from  the 
sterilizing  influence  of  gonorrhea  upon  the  productive  energy  of  the 
family,  and  the  blighting  destructive  effect  of  syphilis  upon  the  off- 
spring are  enormous.     In  the  opinion  of  very  competent  j  udges  social 

oW.  T.  Sedgwick,  "The  Call  to  Public  Health,"  Science,  1908,  p.  198. 

6  Report  upon  the  Prevalence  and  Geographic  Distribution  of  Hook-worm 
Disease  in  the  United  States,"  Hygienic  Laboratory,  Bulletin  No.  10,  February, 
1903,  Washington. 

c  "  Reports  of  Commission  on  the  Suppression  of  Uncinariasis,  1904,  1905, 
1906-7,  1907-8,  San  Juan,  P.  R."  This  commission  has  been  succeeded  by  a 
bureau,  the  "  Anemia  dispensary  service." 

<»  See*  L.  O.  Howard,  Report  to  Conservation  Commission,  "  Economic  loss  to 
the  people  of  the  United  States  through  insects  that  carry  disease." 


658  KEPORT   OF   NATIONAL,  CONSERVATION   COMMISSION. 

disease  constitutes  the  most  powerful  of  all  factors  in  the  degenera 
tion  and  depopulation  of  the  world. 

Among  the  troops  stationed  in  the  Philippines,  the  venereal  mor 
bidity  during  the  year  1904  was  297  per  1,000,  largely  exceeding  th< 
morbidity  from  malarial  fevers  and  diarrhea;  22  out  of  every  1,00( 
soldiers  were  constantly  ineffective  from  venereal  diseases,  four  times 
as  many  as  from  any  other  disease. 

The  statistics  of  the  Navy  Department  show  during  the  same  year 
that  venereal  disease  was  chargeable  with  a  percentage  of  25.S 
of  the  total  number  of  sick  days  in  the  hospital  from  all  causes 
combined.  In  four  years  949  men  were  discharged  from  the  navj 
for  disability  from  venereal  disease.  The  statistics  of  the  English 
army  show  that  among  the  troops  stationed  in  India  537  per  1,000 
were  admitted  to  the  hospital  for  venereal  disease.  Of  the  troops  re 
turning  home  to  England  after  completing  their  time  of  service  in 
India,  25  per  cent  were  found  to  be  infected  with  syphilis. 

No  statistics  exist  for  venereal  disease  in  civil  life.  It  may  be  more 
prevalent  than  in  the  army  and  navy  service,  since  the  inhibitory 
influence  of  military  restraint  and  discipline  do  not  exist  and  the 
opportunities  for  licentious  relations  are  more  abundant.  ] 

Neisser,  a  distinguished  German  authority,  states  that  "  fully  75; 
per  cent  of  the  adult  male  population  contract  gonorrhea  and  15  per 
cent  have  syphilis." 

AVliat  syphilis  and  gonorrhea  represent  in  the  lowered  working 
efficiency  of  our  population — to  say  nothing  of  the  still  more  impor- 
tant subject  of  increased  mortality— -^is  impossible  to  estimate;  but  it 
would  be  difficult  to  overemphasize  the  grave  danger  to  national  ef- 
ficiency from  these  and  the  other  venereal  diseases.  And  here  again 
the  most  strildng  point  is  that  the  venereal  diseases  are  preventable. 

Alcoholism  and  drug  addiction  are  maladies  of  frightful  preva- 
lence. They  are  so  familiar  as  to  be  taken  by  many  as  a  matter  of 
course. 

Venereal  diseases  and  inebriety,  whether  alcoholic  or  drug,  fre- 
quently lead  to  insanity.  Statistics  are  not  yet  able  to  prove  con- 
clusively that  insanity  is  increasing,  though  this  is  the  opinion  of  the 
best  judges." 

Dr.  C.  L.  Dana,  formerly  president  of  the  New  York  Academy  of 
Medicine,  believes  the  increase  in  insanity  to  be  real  as  well  as  ap- 
parent. He  says :  "  The  annual  increment  of  insane  in  Massachusetts, 
according  to  the  Massachusetts  board  of  lunacy,  is  400  in  about  10,000, 
or  4  per  cent."  At  this  ratio  the  annual  increment  for  the  United 
States  would  be  approximately  5,600.  "  We  may  say  that  in  the  last 
twenty-five  years  the  ratio  of  insane  to  sane  has  shown  an  apparent 
gradual  increase  from  1  to  450  to  1  to  300,  and  this  latter  seems  to  be 
about  the  ratio  in  those  communities  of  North  America  and  Europe  in 
which  modern  conditions  of  civilization  prevail.  This  average  has 
varied  but  little  in  the  last  few  years;  the  slight  yearly  increase  prob- 
ably will  not  change  rapidly  and  probably  not  continue,  for  when  the 
increase  in  the  insane  reaches  a  certain  point  of  excess  society  will 
have  to  take  notice  of  it  and  correct  it."  ^    There  are  no  accurate  fig- 

<»  For  a  critical  examination  of  statistical  data  on  insanity,  see  Humphreys, 
(Noel,  A.),  "The  alleged  increase  of  insanity,"  Journal  of  the  Royal  Statisti- 
cal Society,  June,  1907. 

^  "  Psychiatry  in  its  Relation  to  Other  Sciences,"  section  on  psychiatry  at  the 
International  Congress  of  Arts  and  Sciences,  St  Louis,  September,  1904. 


FisnEH.l  NATIPNAL  VITALITY.  659 

[ures  of  the  number  of  insane.  Mr.  Sanborn  estimates  that  the  number 
exceeds  250,000  in  the  United  States. 

j  Among  defective  and  disabled  classes  are  to  be  especially  mentioned 
ithe  feeble-minded,  paralytic,  crippled,  blind,  and  deaf  mutes.  The 
aggregate  disability  of  these  groups  is  greater  than  is  commonly 
recognized.    The  preventability  is  still  less  appreciated. 

With  reference  to  the  losses  each  year  from  industrial  accidents: 

The  statistical  report  of  the  Interstate  Commerce  Commission  for 
the  year  ending  June  30,  1907,  shows  that  during  that  year  11,800 
persons  were  killed  and  111,000  injured  on  our  American  railways, 
I  these  figures  including  passengers,  employees,  and  all  other  persons. 
;A  large  number  of  the  victims  were  railway  employees,  for  whose 
safety  Congress  has  passed  a  number  of  laws.  The  total  number  of 
[cases  of  industrial  accidents  can  not  be  estimated,  owing  to  the  lack 
•of  statistical  information ;  but  Census  Bulletin  83  gives  the  number  of 
deaths  b}'  accident  and  violence  in  1900  at  57,500. 

"  Of  29,000,000  workers  in  the  United  States  over  500,000  are  yearly 
killed  or  crippled  as  a  direct  result  of  the  occupations  in  which  they 
;are  engaged — more  than  were  slain  and  wounded  throughout  the 
iwhole  Russo-Japanese  war.  More  than  one-half  this  tremendous  sac- 
rifice of  life  is  needless."  " 

Mr.  Frederick  L.  Hoffman  estimates  *  that  the  number  of  accidents 
among  men  employed  in  the  United  States  in  1906  was  208,000,  of 
which  about  5,000  were  fatal.  These  figures  are  exclusive  of  mining, 
railway,  and  shipping  accidents. 

John  Mitchell "  estimates  that  for  every  100,000  tons  of  coal  pro- 
duced in  the  United  States  one  mine  worker  is  killed  and  several 
injured.  In  1907  the  figures  were  2,500  coal  miners  killed  and  6,000 
seriously  injured. 

In  Wisconsin  from  October  1,  1906,  to  October  1,  1907,  the  total 
number  of  accidents  reported  which  incapacitated  the  victim  by  at 
least  two  weeks  was  13,572.  The  accidents  to  employees  constituted 
53  per  cent  of  this  number.* 

I  Special  trades  have  special  perils  for  workmen.  "Among  diseases 
'to  which  workmen  are  most  often  subject  are  the  so-called  '  inanition, 
'scrofula,  rachitis,  pulmonary  consumption,  dropsy;'  also  rheumatic 
■.roubles,  pleurisy,  typhoid  fever,  gangrene,  and  the  various  skin  dis- 
eases. Every  epidemic,  be  it  typhoid,  smallpox,  scarlet  fever,  dysen- 
:ery,  cholera,  etc.,  draws  its  greatest  army  of  victims  from  this  classl 
For  every  death  that  occurs  among  the  richer  and  higher  classes 
:here  are  many  in  the  working  class.  It  is  the  workman  engaged  in 
mhealthy  factories  first  of  all  who  fills  the  hospitals  and  their  death 
chambers."  * 

It  is  the  pollution  of  the  air  breathed  by  workmen,  whether  the 
pollution  come  through  poisons  or  through  dust,  that  makes  many 
.rades  dangerous.    Among  poisonous  trades  are  the  many  lead-using 


0  Ditman,  loc.  cit.,  43. 

^  In  an  article  contributed  to  the  "  New  Encyclopedia  of  Social  Reform,"  1908. 

'  Speech  before  the  Governor's  Conference  on  Conservation,  White  House, 
May,  3  908. 

<*  Thirteenth  biennial  Report,  Bureau  of  Labor  and  Industrial  Statistics,  Madi- 
son, Wis.,  1908. 

^  C.  F.  W.  Doehring,  "  Factory  Sanitation  and  Labor  Protection,"  Bulletin 
Department  of  Labor  No.  44,  January,  1903,  p.  2. 


660 


EEPORT    OF    NATIONAL   CONSERVATION   COMMISSION. 


industries,  foundries,  and  chemical  factories.     Investigations  of  the 
dust-producing  trades  have  been  made,  showing  the  results  on  tht, 
respiratory  systems. 

Hirt's  statistics  show  that  men  employed  in  dust-producing  occu-| 
pations  suffer  much  more  frequently  from  pneumonia  and  consump- 
tion than  do  those  not  exposed  to  dust.  The  relative  frequency  ol_ 
these  diseases  per  100  workmen  is  as  follows: 

Cases  of  consumption  and  pneumowia  per  100  workers  in  certain  occupations. 


Consump- 

Pneu- 

tion. 

monia. 

28 

17. 

25.2 

6. 

22.6 

6. 

20.8 

7. 

13.3 

9. 

11.1 

o4. 

Workers  in  metallic  dust 

Worlrers  in  mineral  dust 

Workers  in  mixed  dust 

Workers  in  animal  dust 

Workers  In  vegetable  dust. . 
Workers  in  nondusty  trades. 


«  George  M.  Kober,  M.  D.,  "  Industrial  Hygiene,"  Bulletin  of  Bureau  of  Labor,  Marchi 
1908,  p.  477. 

Mr.  Owen  R.  Lovejoy,  secretary  of  the  national  child-labor  com- 
mittee, has  condensed  a  table  from  Indiana  reports  "  showing  the  high 
injury  rate  suffered  by  children  in  the  industries. 

Injuries  to  children  in  Indiana,  1907. 
Proportion  of  adults  injured (  ^  P^^  J' J^ 

Proportion  of  children  injured j;^  ^^^^'  f  ^^r 

UO  per  1,  OOC 

The  injury  rate  for  children  is  shown  to  be  three  to  four  times  as 
great  as  for  adults. 

Chapter  IV. — Prevalence  of  ininor  ailments. 
Section  1. — Importance  of  minor  ailments. 

The  statistics  of  morbidity  which  we  have  given  refer  to  forms 
which  are  relatively  acute;  but  there  are  many  milder  forms  which 
do  not  incapacitate  the  patient  from  work  or  compel  him  to  take! 
to  his  bed.  The  extent  of  these  milder  ills  is  not  generally  appre- 
ciated. They  are  often  carefully  guarded  secrets.  The  individual 
often  knows  only  his  own  physical  troubles,  but  is  unaware  of  the 
fact  that  almost  every  person  about  him  has  such  troubles  also.  Once 
you  penetrate  beneath  conventional  acquaintance  there  will  almost 
invariably  be  found  some  functional  impairment  of  heart,  liver, 
kidneys  or  bladder;  or  dyspepsia,  gastritis,  jaundice,  gallstones, 
constipation,  diarrhea;  or  insomnia,  neurasthenia,  nervousness,  neu- 
ritis, neuralgia,  sick  headache;  or  tonsilitis,  bronchitis,  hay  fever, 
catarrh,  grip,  colds,  sore  throat;  or  rupture,  hernia,  phlebitis,  skin 
eruption;  or  rheumatism,  lumbago,  gout,  obesity;  or  decayed  teeth, 
baldness,  deafness,  eye  ailment,  spinal  curvature,  lameness,  broken 
bones,  dislocations,  sprains,  bruises,  cuts,  burns,  or  other  "  troubles." 

"  "  Eleventh  Annual  Report  of  the  Department  of  Inspection  of  Indiana,  1907," 
Exhibit  O,  pp.  166-198. 


nsHKB.l  NATIONAL  VITALITY.  '  661 

These  so-called  "  minor  ailments  "  will  undoubtedly  in  the  next  few 
years  receive  much  more  attention  than  now.  Until  recently  the 
physician  has  been  accustomed  to  treat  only  acute  diseases,  but  as 
preventive  medicine  gradually  replaces  curative  medicine  the  physi- 
cian will  be  more  called  upon  to  treat  minor  ailments.  These  are 
generally  the  first  warnings  of  more  serious  troubles.  If  what  seem 
to  be  "  mere  colds  "  were  less  commonly  neglected,  tuberculosis  would 
more  often  be  caught  in  its  incipiency,  and  pneumonia  and  diphtheria 
would  often  be  prevented. 

From  the  "  common  colds  "  also  tonsilitis  and  abscess  of  the  ear  can  and  do 
M)nie,  purulent  inflammations  of  the. pneumatic  and  venous  cavities  of  the  face 
and  skull,  and  meningitis  and  cerebral  abscess — all  of  which  destroy  many 
lives  annually ;  or  the  lives  may  be  saved  by  a  surgical  operation  after  a  serious 
and  prolonged  illness.  Tonsilitis,  in  turn,  in  addition  to  lighting  up  furious 
inflammations  in  its  own  immediate  vicinity,  can  be  held  responsible  in  a  cer- 
tain number  of  cases  for  serious  diseases  at  a  distance  from  its  ov?n  site.  These 
ire  septic  arthritis  (inflammation  of  joints),  septic  peritonitis,  appendicitis, 
endocarditis  (valvular  disease  of  the  heart) — severe  and  frequently  fatal  dis- 
eases. Gastritis  or  gastroenteritis,  sick  headache,  jaundice,  lumbago,  are  not 
usually  of  serious  import,  but  sometimes  are  the  signs  that  point  to  an  under- 
tying  cause  (alcoholism,  overeating,  chronic  protein  intoxication,  worry — busi- 
oess  or  domestic — sedentary  life,  etc.)  which  will  lead  later  to  arteriosclerosis, 
chronic  nephritis,  toxic  amblyopia  (optic  nerve  blindness),  cirrhosis  of  the  liver, 
cerebral  hemorrhage  or  valvular  disease  of  the  heart." 

If  the  first  twinges  of  rheumatic  pains  were  heeded,  gout  and  the 
dreaded  arthritis  deformans  would  lose  most  of  their  terrors.  We 
could  then  arrest  a  great  majority  of  serious  affections  at  the  very 
gateway.  It  can  hardly  be  doubted  that  even  such  diseases  as  cancer, 
whose  causation  is  not  yet  understood,  gain  a  foothold  through  low- 
ered vital  resistance,  manifesting  itself  at  the  first  in  minor  ailments 
af  some  kind. 

I  The  American  neurasthenia,  widespread  and  subtle,  has  its  grip  on 
thousands  of  men  and  women,  driving  them  from  home  and  offices 
annually  to  sanitaria  or  various  health  resorts,  and  so  breaking  down 
their  average  vitality  as  to  render  them  much  more  liable  to  serious 
sickness  and  death. 

This,  the  most  widely  prevalent  of  all  nervous  disorders  in  this 
country,  seems  to  be  on  the  increase.  It  is  very  commonly  found 
among  persons  who  take  no  reasonable  recreation — many  business 
men,  among  others — and  the  loss  of  time  and  incapacitation  for  work 
lare  very  great,  often  weeks  and  months  at  a  time. 

As  to  the  extent  to  which  minor  ailments  exist,  no  statistics  are 
available.  Doctor  Castle,  of  Cincinnati,  estimates,  from  an  experi- 
ence of  many  years  in  the  medical  supervision  of  institution  em- 
ployees and  general  practice,  that  there  is  an  average  of  at  least  three 
days'  time  lost  annually  for  each  person  in  the  population  because  of 
such  minor  ailments.  Similarly,  Dr.  J.  F.  Morse,  of  the  Battle  Creek 
Sanitarium,  who  has  had  a  long  experience  in  dealing  with  a  large 
number  of  cases,  estimates  that  the  average  "  well  man  "  loses  on  an 
average  five  days  a  year  from  work  on  account  of  headaches,  tooth- 
aches, "  colds,"  and  similar  minor  ailments  which  do  not  come  under 
the  head  of  any  of  the  diseases  reported. 

•  Letter  from  Dr.  Chas.  H.  Castle. 


662  REPORT   OF   NATIONAL.  CONSERVATION   COMMISSION. 

Section  2. — Preventahility  of  minor  ailments. 


f' 


lai 


I 


That  almost  all  minor  ailments  can  be  avoided  is  scarcely  to  h 
doubted.  Doctor  Gulick  is  "  inclined  to  believe  that  something  lik. 
nine-tenths  of  all  the  minor  ailments  that  we  have,  and  which  consti 
tute  the  chief  source  of  decreasing  our  daily  efficiency,  could  bi 
removed  by  careful  attention."  "  With  the  removal  of  nine-tenths  o 
our  disabilities  and  the  conservation  and  further  development  of  ou 
natural  powers,"  he  adds,  "  the  average  person  can  increase  his  effi 
ciency  100  per  cent,  that  is,  he  can  be  twice  as  effective.  This  doei 
not  refer  to  doing  merely  or  mainly  twice  as  much  work,  of  course 
but  by  making  less  mistakes,  and  by  working  at  a  higher  degree  oj 
speed  when  he  does  work.  By  working  under  conditions  so  that  th< 
work  does  not  need  to  be  repeated,  the  whole  total  will  be  mucl 
greater — I  think  not  too  much  to  say  twice  as  great — as  under  ordi 
nary  conditions." 

Minor  ailments  are  preventable  by  leading  a  .reasonably  hygienic 
life  and  by  revising  the  modern  gospel  of  "  hustle  " — which  lattei 
usually  means  crude,  imperfect,  and  slovenly  work,  whether  menta 
or  manual.  The  j^revention  of  these  diseases  would  "  cost  "  nothing — 
for  it  costs  nothing  to  stay  well. 

If,  again,  we  consider  the  experience  of  those  who  have  made  a 
serious  attempt  to  avoid  minor  ailments,  their  preventability  becomes 
clear.  Personally,  I  have  laiown  of  scores  of  cases  in  which  the  tend 
ency  to  catch  cold  has  been  almost  completely  overcome.  In  on( 
case  a  physician,  who  as  a  boy  had  suffered  from  continual  colds  and 
hay  fever,  succeeded,  through  the  simplification  and  control  of  his 
diet,  in  attaining  almost  complete  emancipation,  which  has  lasted  over 
forty  years.  Another  physician  reports  that  for  ten  years,  during 
which  time  he  has  taken  special  means  to  produce  complete  evacua 
tion,  he  has  not  caught  a  single  cold.  A  large  number  of  cases  ob 
served  are  of  persons,  physicians  as  well  as  laymen,  who  have  taken 
the  outdoor  cure  for  tuberculosis  or  nerrous  prostration.  These 
persons  not  only  succeeded  in  combating  these  serious  troubles,  but 
in  completely  freeing  themselves  from  liability  to  colds.  Evidently,' 
if  the  outdoor  life  had  been  adopted  simply  as  a  preventive  of  colds, 
it  would  have  prevented  originally,  as  it  cured  subsequently,  their: 
more  serious  disorders. 

Chapter  V. — Prevalence  of  undue  fatigue. 

Section  1. — Strength,  endurance,  and  fatigue. 

When  a  person  is  free  from  all  specific  ailments,  both  serious  and 
minor,  he  usually  calls  himself  "  well."  There  is,  however,  a  vast 
difference  between  such  a  "well"  man  and  one  in  ideally  robust i 
health.  The  difference  is  one  of  endurance  or  susceptibility  to 
fatigue.  Many  "  well  "  men  can  not  run  a  block  for  a  street  car  or 
climb  more  than  one  flight  of  stairs  without  feeling  completely  tired, 
out,  while  another  "  well  "  man  will  run  25  miles  or  climb  the  IVIatter- 
hom  from  pure  love  of  sport.  The  Swiss  guides,  throughout  the 
summer  season  day  after  day,  spend  their  entire  time  in  climbing. 
A  Chinese  cooly  will  run  for  hours  at  a  stretch.  That  the  world 
regards  such  performances  as  "  marvelous  feats  of  endurance  "  only , 


nsHER.]  NATIONAL  VITALITY.  663 

5hows  how  marvelously  out  of  training  the  world  as  a  whole  really 
s.  In  mental  work  some  persons  are  unable  to  apply  themselves  more 
■than  an  hour  at  a  time,  while  others,  like  Humboldt  or  Mommsen,  can 
nvork  almost  continuously  through  fifteen  hours  of  the  day. 
i  As  Mosso  <*  and  others  have  proved,  muscular  fatigue  is  a  chemical 
jffect,  due  to  the  circulation  of  "  fatigue  poisons  "  in  the  blood.  This 
'las  been  strikingly  shown  by  experiments  by  Weishardt  and  others 
)n  dogs;  when  blood  is  transfused  from  an  exhausted  dog  to  a 
'  frisky "  one,  the  latter  immediately  wilts  and  becomes  fatigued 
ike  the  former,  although  he  has  not  exerted  himself  in  the  least.  In 
)rder  to  reduce  fatigue,  therefore,  we  should  keep  down  fatigue 
Doisons.  It  is  not  unlikely  that  almost  all  poisons  produce  fatigue, 
whether  the  poisons  come  from  infections,  from  drugs,  from  impure 
)r  excessive  food,  from  bad  air,  or  from  exertion. 

It  should  be  noted  that  endurance  is  a  quality  quite  distinct  from 
strength,*  Strength  is  measured  by  the  utmost  force  a  muscle  can 
ixert  once;  endurance  by  the  number  of  times  it  can  repeat  an  ex- 
ertion requiring  a  specified  fraction  of  available  strength  at  the  start. 
Thus,  if  each  one  of  two  men  is  barely  able  to  lift  a  dumb-bell  weigh- 
ng  100  pounds,  their  strengths  are  equal,  but  if  one  of  them  can  raise 
I  dumb-bell  weighing  50  pounds  20  times,  while  the  other  can  raise  it 
0  times,  the  latter  may  be  said  to  have  double  the  endurance  of  the 
brmer.  Another  mode  of  expressing  the  same  thought  is  that  endur- 
mce  is  measured  by  the  slowness  with  which  strength  decreases 
hrough  exertion. 

Section  2. — Alcohol  and  fatigue. 

Of  all  poisons  in  ordinary  use,  alcohol  and  tobacco  are  the  most 
;ommon.  That  alcohol  increases  fatigue  is  now  commonly  recognized 
)y  athletes.  "Alcohol  gives  no  persistent  increase  of  muscular  power, 
't  is  well  understood  by  all  who  control  large  bodies  of  men  engaged 
n  physical  labor  that  alcohol  and  effective  work  are  incompatible."  " 

One  of  the  most  interesting  features  of  the  cycling  sport,  when  long 
,ours  were  the  fashion  a  few  years  ago,  was  the  fact  that  the  wayside 
;eller  of  drinks  found  himself  forced  to  supply  chiefly  "  temperance 
Irinks."  The  cyclists  discovered  that  they  could  not  make  their  "  cen- 
.ury  runs  "  on  alcoholic  beverages.  Two  friends  report  that  they 
topped  for  refreshments  and  drank  beer.  Resuming  their  ride  they 
ound  it  hard  to  propel  the  machine,  and  both  ima^ned  some  obstruc- 
■ion  had  lodged  in  the  gears.  Only  after  having  dismounted  and  sat- 
sfied  themselves  to  the  contrary  did  they  come  to  the  conclusion, 
whether  rightly  or  wrongly,  that  the  resistance  was  in  their  own  legs 
Hid  was  due  to  the  beer. 

Careful  experiments  with  alcohol  in  relation  to  fatigue  have  been 
eported  by  Rivers,"*  who  shows  that  alcohol  diminishes  the  capacity 

"See  Fatigue,  English  translation.    New  York  (Putnapi),  1904, 

'' See  Irving  Fisher:  The  Effect  of  Diet  on  Endurance.  (Publications  of  Yale 
Jniversity,  Transactions  of  the  Connecticut  Academy  of  Arts  and  Sciences; 
Jew  Haven,  1906,  p.  1.) 

"  The  Liquor  Problem,  a  summary.  Report  of  subcommittee  of  committee  of 
ifty  on  physiological  aspects  of  the  liquor  problem.  New  York  ( lloiiiiliton- 
lifflin),  1.905.     . 

*W.  H.  R.  Rivers:  "Influence  of  Alcohol  on  Fatigue,  etc."  London  (Edward 
irnold),  1908,  pp,  89-90. 

I 


664  REPORT   OF   NATIONAL   CONSERVATION   COMMISSION. 

for  exertion.  Experiments  carried  on  by  Professor  Aschaffenburg 
with  four  typesetters,  all  users  of  alcohol,  showed  that  on  days  when 
Greek  wine,  containing  18  per  cent  of  alcohol,  was  given  the  men 
there  was  considerable  diminution  of  the  capacity  for  work.  On 
the  alcohol  days  two  of  the  men  did  decidedly  less  work,  while  the 
work  of  the  remaining  two  was  marked  by  great  irregularity. 

The  injury  from  alcohol  is  mitigated,  but  not  excluded,  through 
combination  with  sugar,  malt,  and  other  beneficial  ingredients,  as, 

in  beer. 

Section  3. — Tobacco  and  fatigue. 

As  to  tobacco  it  is  a  common  observation  that  smoking  interferes 
with  one's  "  wind  "  in  nmning.  The  poisons  which  probably  bring 
about  this  result  include  others  than  nicotine.  Possibly  the  most 
important  poison  is  carbon  monoxide,  which  has  a  great  affinity  for 
the  iron  in  the  blood."  "When  the  smoker  "  inhales,"  this  poison, 
probably  joined  with  others,  enters  directly  into  the  blood  stream. 

In  an  experiment  carried  on  by  Doctor  Lombard,  "  smoking  was 
found  to  have  a  very  depressing  effect  upon  the  strength  of  the 
voluntary  muscular  contractions.  *  *  *  Undoubtedly  the  effect 
of  tobacco  to  lessen  the  voluntary  power  is  due  to  its  influence  upon 
the  central  nervous  system."  ^ 

It  is  the  testimony  of  many  users  of  tobacco  that  the  habit  of 
smoking  leads  to  nervousness  and  disinclination  to  exertion  directly 
after  smoking. 

Experimentation  has  shown  that  smoking  increases  blood  pressure 
The  greater  resistance  to  circulation  offered  by  the  blood  is  pre- 
sumably due  to  the  excitation  caused  by  the  introduction  into  the 
blood  stream  of  foreign  matter  from  the  tobacco.  There  is  reason 
to  believe,  though  the  fact  has  not  been  established,  that  endurance 
is  lessened  by  high  blood  pressure. 

Section   4. — Diet  and  fatigue. 

Poisons  may  also  enter  the  system  through  food.  Many  poisons 
come  from  diseased,  contaminated,  or  adulterated  foods;  but  they  may 
also  be  due  to  excess  of  food  or  wrong  preparation  of  foods,  and  espe- 
cially to  the  decomposition  of  protein  (the  principal  ingredient  of 
white  of  egg  and  lean  meat)  in  the  colon.  The  absorption  of  such 
poisons  causes  auto-intoxication. 

It  has  long  been  known  by  physiologists  that  the  putrefaction  in 
the  intestines  is  the  putrefaction  of  protein.  But  only  recently  have 
they  raised  the  question  whether  a  reduction  of  the  protein  element ' 
of  food  would  be  feasible  and  whether  the  resulting  reduction  in 
putrefaction  and  auto-intoxication  might  not  be  advantageous.' I 
These  questions  are  still  under  debate,  but  the  trend  of  physiological 
opinion  is  increasingly  in  favor  of  protein  reduction.  Practically 
this  means  a  lessening  of  the  consumption  of  lean  meat  and  eggs.       . 

"'♦The  toxicity  of  tobacco  smoke,"  The  Lancet,  CLXXV,  1908,  p.  104. 

'  Warren  P.  Lombard,  M.  D.,  "  Some  of  the  influences  which  affect  the  power 
of  voluntary  muscular  contraction."  Journal  of  Physiology,  Vol.  XIII,  1892, 
p.  48. 

*  See  C.  A.  Herter,  "  Bacterial  Infections  of  the  Digestive  Tract,"  New  York 
(Macmillan),  1907. 


FISHER.]  NATION  All  VTTALITT.  665 

Evidence  has  accumulated,  though  it  has  not  yet  been  put  in  proper 
experimental  form  for  absolute  proof,  that  auto-intoxication  is  not 
only  "an  exceedingly  common  affection,  but  also  the  chief  cause  of 
undue  fatigue.  Most  persons  know  the  heavy  feeling  and  disinclina- 
tion to  e^^ertion  which  generally  accompany  constipation,  and,  on 
tho  other  hand,  the  relief  which  comes  with  a  complete  evacuation. 

Leaving  auto-intoxication  aside,  Professor  Chittenden  is  of  the 
opinion  that  waste  products  from  combustion  of  protein  are  probably 
responsible  for  fatigue.  Whatever  the  explanation.  Professor  Chit- 
tenden found  in  his  classical  experiment"  with  a  squad  of  soldiers, 
that  strength  and  endurance  were  increased  by  a  reduction  of  the 
protein.  Thirteen  soldiers  were  placed  for  six  months  on  a  diet  con- 
taining a  much  smaller  quantity  of  protein  food  than  what  is  pre- 
scribed by  ordinary  dietary  standards  and  containing  only  one-third 
of  what  is  demanded  by  common  American  usage.  Professor  Chit- 
tenden's results  are  gaining  recognition,  but  they  will  need  to  be 
further  tested  before  any  unanimity  of  opinion  can  be  reached. 

Analysis  of  the  diet  of  several  hundred  vegetarians  shows  that  on 
the  whole  they  are  lower  in  protein  than  the  average  American. 
Comparative  experiments  on  17  vegetarians  and  25  meat  eaters  in  the 
laboratory  of  the  University  of  Brussels  have  shown  Mttle  differences 
in  strength  between  the  two  classes,  but  a  marked  superiority  of  the 
vegetarians  in  point  of  endurance.  The  average  superiority  was  53 
per  cent.  The  vegetarians  recuperated  from  fatigue  more  quickly 
than  the  meat  eaters.^  To  what  extent,  if  at  all,  the  superiority  of 
the  vegetarians  was  due  to  vegetarianism  as  such,  and  to  what  extent 
to  the  fact  that  they  made  a  more  moderate  use  of  protein,  can  not 
be  exactly  determined,  although  the  evidence  indicates  that  the  lower 
protein  is  the  essential  factor.  The  virtues  and  drawbacks  of  vege- 
tarianism as  such  have  as  yet  received  almost  no  scientific  study." 
Professor  Chittenden  is  now  engaged  in  such  a  study. 

In  another  experiment,  comprising  49  subjects  and  contrasting 
those  on  high  and  low  protein  diets,  it  was  found  that  the  low  pro- 
tein subjects  had  greater  endurance.''  For  instance,  the  test  of 
"deep-knee  bending"  showed  that  whereas  the  high-protein  subjects 
could  seldom  exceed  400  or  500  times,  the  low-protein  men  could  fre- 
quently exceed  1,000,  and  in  one  case  reached  2,400. 

The  writer  has  in  his  possession  several  hundred  unpublished  in- 
dividual records  of  men  on  a  low  and  high  protein  diet.  These,  on 
the  whole,  seem  to  show  a  considerable  superiority  in  endurance 
among  those  using  the  lesser  amounts  of  protein.  But  while  the  trend 
of  evidence  seems  at  present  to  favor  a  reduction  in  protein,  the  ques- 
tion is  not  yet  settled.*    There  exist  many  conspicuous  cases  of  high 

«  See  Russell  H.  Chittenden,  "  Physiological  Economy  in  Nutrition,"  New  York 
(Stokes),  1904,  and  "The  Nutrition  of  Man,"  New  York   (Stokes),  1907. 

^  "  Enquete  Scientifique  sur  les  Vegeteriens  de  Bruxelles,"  par  Mile,  le  Dr.  J. 
loteyko  and  Mile.  Varia  Kipiani,  Bruxelles  (Lemartin),  1907.  For  EJnglish 
abstract  see  "  Diet  and  Endurance  at  Brussels,"  Science,  Vol.  XXVI,  1907,  pp. 
561-563, 

"An  exception  is  Caspari,  "  Physiologische  Studien  iiber  Vegetarismus," 
Bonn  (Hager),  1905;  see  also  Gautier,  "Diet  and  Dietetics,"  English  transla- 
tion, London,  1906. 

<*  Irving  Fisher,  "  Influence  of  flesh  eating  on  endurance,"  Yale  Medtlcal  Jour- 
nal, March,  1907. 

*  See,  for  example,  Prof.  F.  G.  Benedict's  paper  on  "  The  nutritive  require- 
ments of  the  body,"  American  Jourual  of  Physiology,  Vol.  XVI,  1906,  pp. 
409-437. 


666  REPORT   OF   NATIONAL  CONSERVATION   COMMISSION. 

protein  and  great  endurance.     A  striking  instance  is  that  of  the 
pedestrian  Weston.  , 

In  an  experiment  on  nine  healthy  students,  the  writer  found  that 
thorough  mastication  seemed  to  cause  a  gradual  decrease  in  protein. 
The  significance  of  the  experiment  lay  in  the  improvement  "in  physi- 
cal endurance  of  eight  of  the  men,  which  increased  over  90  per  cent 
in  five  months.  The  ninth  man — the  only  one  whose  protein  was  not 
greatly  reduced — failed  to  improve  in  endurance." 

Section  5. — Exertion  and  fatigue. 

Exertion  increases  combustion  of  oxygen,  and  the  capacity  for  ex- 
ertion is  intimately  related  to  the  completeness  of  this  combustion. 

Experiments  in  artificially  administering  oxygen  to  athletes  have 
been  made  in  England  by  Hill,  Flack,  Pombrey,  and  others.^  Fol- 
lowing these,  a  series  of  experiments  in  swimming  recently  took 
place  at  Huntington,  L.  I.  The  swimmers  to  whom  oxygen  had  been 
administered  surpassed  their  nonoxygenized  competitors  as  well  as 
their  own  previous  natural  records.  Doctor  Bising,  who  carried  on 
the  experiment,  states  that  the  effects  of  oxygen  inhalation  are  useful 
for  short  efforts  only.  At  most  the  oxygen  exercises  its  influence 
for  not  more  than  three  minutes. 

Perhaps  the  most  important  of  the  common  influences  affecting  the 
capacity  to  resist  fatigue  is  physical  exertion.  It  is  well  known  that 
a  man  "  in  training  "  has  greater  endurance  than  one  who  attempts 
exertion  without  previous  systematic  exercise  or  training.  In  general, 
it  may  be  said  that  a  person  in  the  "  pink  of  condition  "  is  fit  not 
only  for  physical  but  also  for  mental  exertion.  The  great  majority  of 
adults  are  far  from  being  "  in  condition,"  suffering  either  from  lack 
of  exercise  or  from  too  much  exercise.  The  ordinary  man  errs  either 
in  one  direction  or  the  other.  The  brain  worker  lives  too  sedentary  a 
life,  while  the  manual  worker,  through  fatigue  caused  by  long  hours, 
is  in  a  continual  state  of  overexertion.  Could  these  conditions  be 
remedied,  endurance,  as  measured  by  capacity  to  withstand  prolonged 
strains,  might  be  greatly  increased. 

Experiments  have  shown  that  physical  endurance  can  be  doubled 
by  dietetic  causes  alone,  or  doubled  by  exercise  alone.  By  both 
together  it  is  not  unlikely  that  it  could  be  tripled  or  quadrupled. 
But  when  it  is  said  that  the  endurance,  or  capacity  for  exertion,  of 
the  ordinary  healthy  man  could  be  thus  multiplied,  it  is  not  meant 
that  the  hours  of  his  daily  work,  or  even  his  daily  output  of  work, 
could  be  increased  in  such  a  ratio.  What  it  does  mean  is  the  removal 
of  the  fatigue  limit,  a  freer  and  more  buoyant  life,  and  a  visible 
increase  in  the  quantity  and  quality  of  work  per  hour. 

In  an  ideal  life  fatigue  would  seldom  be  experienced.  But  in 
most  lives,  unfortunately,  fatigue  is  a  daily  experience.  A  workman 
who  gives  intelligent  and  systematic  care  to  the  body  writes  that 
when  after  a  long  day's  work  the  factory  whistle  blows  at  night  he^j 
unlike  his  fellows,  feels  as  fresh  as  when  he  began  work  in  the  morn- 
ing.    Workmen  can  by  such  self-care  mitigate  some  of  the  evils  of; 

« Irving  Fisher,  "  Effects  of  diet  on  endurance,"  loc.  clt. 
"British  Medical  Journal,  1908,  August  22,  p.  499;  also  August  29,  p.  578, 
Journal  of  Physiology,  1908,  XXXVII,  77-112. 


nsHEK.J  NATIONAL.  VITALITY.  667 

"  the  long  day."  But  they  are  amply  justified,  both  in  the  interest 
of  their  own  and  of  national  efficiency,  in  continuing  their  efforts 
toward  a  shortening  of  the  work  day. 

Section  6. — The  ivorking  day. 

The  present  working  day  is  a  striking  example  of  the  failure  to 
conserve  national  vitality.  In  order  to  keep  labor  power  unimpaired, 
the  working  day  should  be  physiological — i.  e.,  it  should  be  such  as 
would  enable  the  average  individual  to  completely  recuperate  over 
night.  Otherwise,  instead  of  a  simple  daily  cycle,  there  is  a  pro- 
gressive deterioration.  A  reduction  in  the  length  of  the  work  day 
would  be  a  chief  moans  of  improving  the  vitality  of  workmen,  as  well 
as  the  worth  of  life  to  them. 

The  fatigue  of  workmen  is  largely  traceable  to  their  long  work 
day  and  serves  to  start  a  vicious  circle.  Fatigue  puts  the  workman 
in  an  abnormal  frame  of  mind.  He  seeks  to  deaden  his  fatigue  by 
alcohol,  tobacco,  exciting  amusements,  and  excesses  of  various  kinds. 
The  momentary  relief  which  he  thereby  obtains  is  purchased  at  the 
expense  of  an  increasing  susceptibility  to  fatigue,  resulting  sooner 
or  later  in  complete  depletion  of  his  vital  energies  and  in  the  con- 
traction of  tuberculosis  or  other  fatal  disease.  The  decrease  in  the 
length  of  the  working  day  has  not  diminished  the  total  output. 

An  instance  in  which  the  eight-hour  day  superseded  the  nine-hour 
day  with  entire  success  is  the  case  of  the  Salf  ord  Iron  Works,  of  Mather 
&  Piatt,  at  Manchester,  England,  which  changed  to  the  eight-hour 
day  in  1893.  As  the  firm's  products  were  subject  to  keen  competition 
in  both  home  and  foreign  markets,  it  was  obliged  to  look  carefully 
after  the  labor  cost,  and  its  conclusion  that  such  cost  did  not  increase 
in  consequence  of  the  reduction  in  working  hours  was  reached  after 
extremely  accurate  comparisons  by  accountants,  who  of  course  took 
into  consideration  the  saving  in  consumables,  wear  and  tear,  fuel,  etc. 
The  Bureau  of  Labor  inquired  of  Messrs.  Mather  &  Piatt  if  they  were 
still  on  the  eight-hour  basis,  and  received  a  reply  dated  May,  24, 1904, 
in  which  they  stated  that— 

our  experience  since  the  first  year  In  which  it  (the  eight-hour  system)  was  tried 
has  fully  borne  out  the  conclusions  then  arrived  at,  and  we  are  fully  satisfied 
that  as  regards  the  comparison  between  eight  and  nine  hours  per  day  the  bal- 
ance of  advantages  is  in  favor  of  the  shorter  period. <* 

In  1894  the  hours  of  labor  of  about  43,000  workmen  in  British  government 
factories  and  workshops  were  reduced  to  forty-eight  per  week.  Of  this  number, 
18,600  received  a  reduction  of  five  and  three-fourths  hours  a  week,  and  24,300 
had  their  time  reduced  two  and  one-half  hours  a  week.  With  no  change  in 
piece  rates  the  workmen  were  able  to  earn  as  much  as  formerly.  Day  workers 
received  an  increased  hourly  rate  of  pay  to  make  their  earnings  per  week  of 
forty-eight  hours  equal  to  those  per  week  of  fifty-four  hours.  It  was  not  found 
necessary  to  increase  the  number  of  day  workers.* 

In  1899  the  owners  of  the  great  Zeiss  optical  goods  factory  at  Jena, 
Germany,  introduced  the  eight-hour  day  and  then  made  careful  rec- 
ords of  the  results.  In  1903  it  was  announced  that  although  the 
aggregate  number  of  hours  worked  had  decreased  15  per  cent  the  out- 
put per  hour  had  increased  16.2  per  cent." 

«  New  York  Labor  Bulletin  No.  25,  June,  1905,  p.  240. 

*  Board  of  Trade  Labor  Gazette,  July,  1905,  reported  in  New  York  Labor 
Bulletin  No.  28,  March,  1906. 
«  New  York  Labor  Bulletin,  No.  25,  June,  1905,  p.  240. 

S.  Doc.  419,  61-2 4 


668  REPORT   OF   NATIONAL  CONSERVATION   COMMISSION. 

At  Liege  it  was  found  in  a  sulphuric  acid  establishment  similar  to 
a  foundry  "  that  shortening  the  working  day  from  eleven  hours  to  ten, 
from  ten  to  nine,  and  so  on  gradually  down  to  seven  and  one-half, 
resulted,  in  each  case,  in  an  increase  of  the  output. 

The  Solvay  Process  Company,  of  Syracuse,  installed  in  1892  a 
system  of  three  eight-hour  shifts  in  place  of  the  two  previous  shifts 
of  eleven  and  thirteen  hours,  respectively.  It  was  stated  by  the 
assistant  general  manager  in  1905  that  the  change  had  considerably 
lessened  the  wear  and  tear  on  the  men,  and  that  they  could  be  called 
on  to  do  their  work  at  their  highest  state  of  efficiency,  which  had  not 
been  possible  on  the  two-shift  basis.  President  Hazard  of  the  com- 
pany writes: 

In  general,  I  can  say  that  the  results  of  the  change  from  a  twelve-hour  shift 
to  an  eight-hour  shift  were  very  satisfactory  and  have  continued  to  be  so. 
While  the  immediate  result  was  to  considerably  increase  the  cost  per  unit  of  prod- 
uct, the  efficiency  of  the  men  gradually  increased,  so  that  at  the  end  of  about 
one  year  the  first  increase  has  been  overcome  and  the  cost  per  unit  of  product 
fell  to  a  point  even  lower  than  had  been  obtained  under  the  twelve-hour  shift, 
and  further  the  time  consumed  per  unit  of  product  has  since  been  so  reduced 
that  we  are  today  and  for  some  time  have  been  operating  with  a  smaller 
number  of  hours  per  unit  of  product  than  we  had  under  the  twelve-hour  shift. 

Further  proof  of  the  benefits  of  the  change  to  the  three-shift  day 
is  furnished  by  the  records  of  the  Solvay  Mutual  Benefit  Association 
for  1891  and  1904.  The  days  lost  per  man  by  sickness  each  year  fell 
from  seven  and  one-half  days  in  1891  to  five  and  one-half  days  in 
1904. 

It  is  not  maintained  that  in  all  cases  productivity  will  be  as  great 
in  eight  hours  as  in  nine.  Cases  to  the  contrary  could  also  be  cited. 
The  point  to  be  insisted  upon  is  not  that  it  is  profitable  to  an  em- 
ployer to  make  the  work  day  shorter,  for  often  it  is  not,  but  to  show 
that  it  is  profitable  to  the  nation  and  the  race.  Continual  fatig-ue  is 
inimical  to  national  vitality,  and  however  it  may  affect  the  commer- 
cial profits  of  the  individual  it  will  in  the  end  deplete  the  vital 
resources  on  which  national  efficiency  depends. 

In  the  interests  of  this  efficiency,  a  longer  time  at  noon  for  lunch 
is  usually  necessary.  The  present  economy  of  lunch  time  is  short- 
sighted, tends  to  food  bolting,  indigestion,  a  drowsy  and  tired  after- 
noon, and  inferior  work.     This  has  been  shown  by  actual  experience.^ 

The  accident  bulletins  of  the  Interstate  Commerce  Commission 
contain  frequent  records  of  disasters  caused  by  the  long  hours  of  rail- 
way employees.  In  a  recent  bulletin,  No.  27,  two  collisions  are  at- 
tributed to  the  mistakes  of  employees  who  have  been  on  duty  much 
longer  than  the  instinct  of  safety  should  allow.  Collision  No.  3,'' 
which  killed  2  and  injured  13,  was  due  to  the  mistake  of  a  station 
operator  who  had  been  on  duty  from  7  a.  m.  to  3.30  p.  m.  and  who 
had  returned  to  duty  at  8  p.  m.  The  collision  took  place  at  12.30 
a.  m.  the  next  morning. 


; 


o  See  L.  G.  Fremont,  "  Une  Experience  Industrielle  de  Reduction  de  la  Journel 
de  Travail,"  Brussels,  Solvay  Institute,  1906. 

*  See  especially  description  of  a  French  experiment  cited  by  Hubert  Higgins 
In  Humaniculture,  New  York  (Stokes),  1906. 

"Accident  Bulletin  No.  27,  January  to  March,  190S. 


■isHEB.l  NATIONAL  VITALITY.  669 

Section  7. — Importance  of  preventing  undue  fatigue. 

The  economic  waste  from  undue  fatigue  is  probably  much  greater 
ihan  the  waste  from  serious  ilhiess.  We  have  seen  that  the  average 
ierious  ilhiess  per  capita  is  usually  about  two  weeks  each  year.  This 
s  about  4  per  cent  of  the  year.  Expressed  differently,  about  4  per 
;ent  of  the  population  is  constantly  sick. 

On  the  other  hand,  the  number  that  suffer  partial  disability 
Jirough  undue  fatigue  certainly  constitute  the  great  majority  of  the 
copulation.  No  observer  can  fail  to  conclude  that  this  is  true  of  the 
:Vmerican  working,  business,  and  professional  classes,  and  the  latest 
Yord  among  the  students  of  school  hygiene  is  that  it  is  true  to  a 
arge  extent  even  among  children.  If  therefore  we  assume  that  only 
')0  i^er  cent  of  the  population  is  suffering  some  impairment  of  its 
)est  powers  through  undue  fatigue,  we  are  on  safe  ground.  The  ex- 
ent  to  which  the  power  of  this  supposed  50  per  cent  of  the  popula- 
ion  is  impaired  must  certainly  exceed  10  per  cent.  When  we  consider 
hat  young  men,  supposed  to  be  perfectly  well,  have  the  enormous 
■com  for  improvement  indicated  in  this  chapter,  and  when  we  con- 
sider the  gratifying  results  of  experiments  with  a  shorter  work  day  it 
.vill  be  seen  that  the  true  impairment  is  probably  several  times  10  per 
;ent.  Yet  if  only  50  per  cent  of  the  population  are  suffering  an  im- 
Dairment  equal  to  only  10  per  cent  of  its  working  powers,  the  result 
s  equivalent  to  5  per  cent  of  the  population  suffering  total  impair- 
nent  which  is  more  than  the  4  per  cent  impairment  from  serious 
llness. 

The  relatively  slight  impairment  of  efficiency  due  to  overfatigue 
•eads  to  more  serious  impairment.  Just  as  minor  ailments  prove  to 
lave  an  unsuspected  importance  when  considered  as  gateways  to 
serious  illness,  so  the  inefficiency  from  fatigue  is  vested  with  great 
dgnificance  as  the  first  step  toward  minor  ailments.  Obviously  if 
overfatigue  could  be  reduced  to  a  minimum,  this  reduction  would 
:arry  with  it  the  prevention  of  the  major  part  of  minor  ailments, 
jyhich  in  turn  would  lead  to  a  great  reduction  in  more  serious  illness, 
md  this  finally  would  lead  to  a  great  reduction  in  mortality.  A 
;ypical  succession  of  events  is  first  fatigue,  then  colds,  then  tubercu- 
losis, then  death.  Prevention,  to  be  effective,  must  begin  at  the 
Deginning. 

But  prevention  is  merely  the  first  step  in  increasing  the  breadth  of 
ife.  Life  is  to  be  broadened  not  only  negatively  by  diminishing  those 
iisabilities  which  now  narrow  it,  but  also  positively  by  increasing  the 
jultivation  of  vitality.  Here  we  leave  the  realm  of  medicine  and 
mter  the  realm  of  physical  training.  The  first  and  lowest  step  is 
^mnastics.  This  is  valuable — far  more  so  than  the  ordinary  seden- 
:ary  man  who  neglects  it  realizes — but  it  is  after  all  a  kind  of  medicine 
lot  altogether  pleasant  to  take  and  far  less  valuable  to  him  who  takes 
t  than  are  athletic  sports,  which  constitute  the  next  highest  stage. 
Beyond  athletic  sports  in  turn  comes  mental,  moral,  and  spiritual 
mlture,  the  highest  product  of  health  cultivation.  It  is  an  encour- 
iging  sign  of  the  times  that  the  ecclesiastical  view  of  the  Middle  Ages, 
which  associated  saintliness  with  sickliness,  has  given  way  to  modern 
^muscular  Christianity,"  typified  in  Young  Men's  Christian  Associ- 
itions  with  their  gymnastics  and  athletics.    This  is  but  one  evidence 


670  REPORT   OF   NATIONAL.   CONSERVATION   COMMISSION. 

of  the  tendency  toward  the  "  religion  of  healthymindedness "  de- 
scribed by  Professor  James.  Epictetus  taught  that  no  one  could  be 
the  highest  type  of  philosopher  unless  in  exuberant  health.  Expres- 
sions of  Emerson's  and  Walt  Whitman's  show  how  much  their  spirit- 
ual exaltation  was  bound  up  with  health  ideals.  "  Give  me  health  and 
a  day,"  said  Emerson,  "  and  I  will  make  the  pomp  of  emperors  ridicu- 
lous." It  is  only  when  these  health  ideals  take  a  deep  hold  that  a 
nation  can  achieve  its  highest  state  of  development.  Any  country 
which  adopts  such  ideals  as  an  integral  part  of  its  practical  life 
philosophy  may  be  expected  to  reach  or  even  excel  the  development 
of  the  health-loving  Greeks. 

The  means  of  securing  both  the  negative  prevention  of  invalidity 
and  the  positive  accumulation  of  vitality  will  form  the  subject  of 
Part  IIL 


II 


t 


t 


1 
i 


Part  III.— METHODS   OF   CONSERVING  LIFE. 

Chapter  VI. — Conservation  through  heredity. 
Section  1. — Heredity  and  environment. 

That  the  -waste  of  life  through  preventable  disease  and  death  is 
mormons  appears  clearly  from  the  facts  already  cited.  The  practical 
problem  is  this :  If  such  waste  is  really  preventable,  what  are  the  con- 
ditions necessary  to  make  prevention  an  accomplished  fact?  There 
ire  two  main  conditions.  First,  a  general  desire  for  improvement; 
second,  a  general  knowledge  of  how  to  secure  that  improvement. 

Once  the  general  public  recognizes  the  needless  waste  of  vitality, 

will  not  be  content  until  that  waste  has  been  eliminated.  To  such 
m  awakening  the  American  instinct  of  economy  is  in  itself  a  power- 
ul  spur.  Practical  men  are  coming  to  consider  it  "  good  business  " 
;o  take  some  care  of  their  own  vital  resources.  As  this  view  gains 
zround,  habits  and  fashions  will  adapt  themselves  to  the  change. 
The  folly  of  the  man  who  loses  his  health  in  the  pursuit  of  wealth, 
md  then  for  the  rest  of  his  days  spends  his  wealth  to  win  back  health, 
s  beginning  to  be  appreciated. 

Human  vitality  depends  upon  two  prianary  conditions,  heredity 
md  hygiene,  or  conditions  preceding  birth  and  conditions  during  life, 
in  other  words,  vitality  is  partly  inherited  and  partly  acquired. 

It  is  well  known  that  cultivated  plants  and  animals  have  been 
greatly  changed  and  developed  by  breeding.  "  The  original  apple, 
is  offered  by  nature  to  mankind,  was  the  small,  sour,  bitter  crab  of 
he  forest,  unpleasant,  indigestible,  innutritions.  *  *  *  jj^  ^^^10 
Doctor  Davenant,  a  writer  on  political  economy,  estimated  that  the 
iverage  weight  of  dressed  cattle  did  not  exceed  370  pounds.  *  *  * 
!n  1846  McCullock  stated  that  '  at  present  the  average  weight  of 
;attle  is  estimated  at  or  about  800  pounds.'"" 

Human  heredity  is  now  dependent  on  haphazard  selection.  Little 
attention  is  paid  by  those  who  contemplate  marriage  to  the  question 
i  how  much  stamina  w^ill  be  transmitted  to  the  next  generation.  The 
tory  was  told  of  a  famous  dog  fancier  who,  when  asked  why  he  paid 
0  much  attention  to  his  dogs  but  delegated  the  care  of  his  children  to 
lurses,  replied:  "My  dogs  have  a  pedigree."  Human  pedigrees,  no 
ess  than  canine,  rest  on  a  physical  basis;  yet  genealogical  records  of 
luman  beings,  while  they  have  much  to  say  of  social  position,  have 
'■ery  little  to  say  of  physical  capacity  or  intellectual  ability.  Those 
vho,  like  Galton  and  Pearson,  believe  in  a  science  of  eugenics,  hope 
hat  the  day  will  come  when  pride  of  inheritance  will  include  as  im- 

«  See  Dr.  Edward  Jarvis,  Political  Economy  and  Health,  Fifth  Report,  Mass. 
Joard  of  Health,  1874.    Doctor  Jarvis  adds  that  human  life  is  as  "expansible" 

i8  animal  life. 

671 


672  REPORT   OF   NATIONAL   CONSERVATION   COMMISSION. 

portant,  if  not  as  the  chief  items,  physical,  mental,  and  moral  stam 
ina.  A  tendency  in  this  direction  can  be  discerned.  When  the  no 
bility  commanded  the  reverence  of  all  classes,  quite  irrespective  o 
ability,  commoners,  however  well  endowed  by  nature,  could  never  ob 
tain  the  same  respect.  But  to-day  the  English  House  of  Commons  i 
more  honored  and  respected  than  the  House  of  Lords. 

Once  the  importance  of  a  physical  pedigree  comes  to  be  rated  a 
its  true  value,  a  man's  pride  in  his  own  inheritance  will  show  itsel 
in  a  correlative  feeling  of  responsibility  for  future  generations.  Fo; 
the  sake  of  children  yet  unborn,  men  and  women  will  set  for  them 
selves  physical  ideals  of  the  highest  order. 

SECTioisr  2. — Eugenics. 

The  whole  question  of  race  improvement  through  heredity  consti 
tutes  the  subject-matter  of  the  new  science  of  eugenics.  The  devotee 
of  this  science  are  at  present  engaged  in  studying  the  laws  of  heredity 
in  all  its  aspects.  The  Mendelian  doctrine  of  heredity,  with  tb 
theories  of  Darwin  and  Weissmann,  are  some  of  the  topics  whicl 
need  to  be  studied  in  reference  to  their  practical  application. 

Until  more  results  have  been  obtained,  it  would  be  premature  t< 
make  great  claims  for  the  possible  future  usefulness  of  appliec 
eugenics.  A  word  may  be  said  to  prevent  misunderstanding  as  to  iti 
aims.  Many  have  supposed  that  the  object  of  eugenics  was  to  brin^ 
about  suitable  marriages  by  compulsion  of  the  Government.  Such  ( 
proposal  would  not  only  be  absolutely  impracticable,  but  would  de 
feat  the  very  ends  aimed  at.  JNIarriage,  above  all  human  choices 
must,  as  a  rule,  be  left  to  the  individual,  guided  by  his  ideals  alone 
By  the  change  of  these  ideals  alone  can  the  character  of  marriagei 
be  influenced.  Sir  Francis  Galton,  the  founder  of  the  science  oJ 
eugenics,  expects  intelligent  public  opinion  to  be  the  chief  guide  ir 
marriage.  Just  as  the  union  of  brother  and  sister  is  tabooed,  and 
the  marriage  of  even  first  cousins"  is  eyed  askance — whether  justly  oi 
not  does  not  matter — so,  if  the  aims  of  eugenists  are  carried  out,  ar 
obviously  unhygienic  marriage  will  be  frowned  upon.  It  was  some- 
what in  this  way  that  the  ancient  Sparta  raised  its  vitality  to  a  high 
point  of  physical  excellence. 

Galton  has  pointed  out  *  that  present  restrictive  rules  of  marriage 
selection  are  endured  without  any  sense  of  loss  of  privilege  or  free 
dom.  For  example,  members  of  the  European  nobility  are,  in  theii 
marriage  choice,  restricted  almost  wholly  to  fellow-aristocrats;  yet 
so  much  has  this  restriction  become  a  part  of  their  ideal  and  creed 
that  the  narrowness  of  the  range  of  choice  is  not  usually  realized. 

Even  granting  that  some  marriages  are  studiously  calculated  to 
win  money  or  title,  a  much  stronger  or  more  pervasive,  although 
unconscious,  influence  is  exerted  by  the  ideals  which  young  men  and 
women  at  marriageable  age  have  formed  of  what  their  compan- 
ions for  life  sliould  be.     Nothing  is  more  certain  than  that  if  from 

"  In  at  least  20  States  the  marriage  of  first  cousins  is  forbidden  by  law.  An 
excellent  discussion  of  this  subject  is  contained  in  "  Consanguineous  Marriages 
in  the  American  Population,"  by  G.  B.  L.  Arner,  Ph.  D.,  New  York  (Longmans), 
1908. 

»"  Sociological  Papers,"  London  (Macmillan),  1906,  Vol.  II,  p.  12. 


riSHEE.]  NATIONAL,  VITALITY.  673 

childhood  they  were  trained  to  regard  vitality  as  the  first  essential  in 
an  ideal  man  or  woman,  this  would  influence  their  personal  fancy. 
Health,  beauty,  and  vitality  are  natural  objects  of  admiration  and 
love.  Titles,  wealth,  and  other  extraneous  attractions  are  not.  To 
lessen  the  public  esteem  for  these,  and  to  increase  the  esteem  for 
natural  human  merit,  will  tend  to  increase  not  only  the  number  of 
healthy  marriages,  but  the  importance  of  the  role  played  by  normal 
love.  Jf,  therefore,  eugenic  ideals  ever  hold  sway,  love  marriages  will 
not  only  continue  to  exist,  but  will  become  more  frequent.  Love  is  a 
primal  and  natural  instinct,  and  the  more  natural  men  and  women 
are,  and  the  more  highly  they  esteem  natural  vitality,  the  more  will 
they  be  guided  by  mutual  attraction. 

If  a  considerable  percentage  of  the  population  once  shall  come  to 
regard  vitality  as  an  essential  endowment,  the  effect  on  mating  will 
be  felt  in  two  ways:  First,  a  larger  percentage  of  healthy  persons 
will  marry,  leaving  a  larger  percentage  of  unhealthy  persons  single; 
second,  healthy  persons  will  mate  with  each  other,  and  unhealthy 
persons,  in  so  far  as  they  marry  at  all,  will  do  so  among  themselves. 
Of  mixed  matings  there  will  be  a  smaller  number.  Both  of  these 
results  will  tend  gradually  toward  the  improvement  of  the  race. 
That  the  first — the  increased  proportion  of  marriages  among  the 
healthy — will  do  so,  is  obvious.  The  second — the  marriage  of  like 
with  like  in  respect  to  health — would,  it  seems  probable,  operate  to 
increase  the  number  of  progeny  of  healthy  couples  and  decrease  that 
of  the  unhealthy,  especially  after  the  first  generation. 

Since  athletics  have  come  into  vogue  it  is  well  known  that  the 
athletic  ideal  has  led  to  athletic  mating.  The  tendency  of  the  present 
devotion  to  athletics  must  be  to  elevate  the  respect  for  physical 
prowess.  The  high  esteem  entertained  in  Japan  for  physical  train- 
ing and  for  hygiene  as  a  guarantee  of  the  fighting  power  of  the 
country,  constitutes  an  object  lesson,  if  not  a  warning,  to  Americans 
who  wish  their  country  to  be  the  peer  of  the  best.  It  would  be  folly, 
of  course,  to  expect  any  change  in  ideals  so  complete  that  there  would 
not  be  numerous  exceptions  to  hygienic  mating,  but,  once  the  bulk  of 
mankind  are  guided  by  a  truer  principle  in  forming  marriages,  the 
effect  on  racial  development  will  make  itself  distinctly  felt  within  a 
generation.  As  President  Roosevelt  has  said:  "The  preservation 
of  national  vigor  should  be  a  matter  of  patriotism."  Some  persons 
would  even  make  it  a  matter  of  religion. 

Section  8. — Eugenics  and  law. 

It  is  possible,  however,  that  governmental  interference  with  the 
birth  rate  may  in  future  be  employed  to  a  limited  extent.  Two  ways 
have  been  suggested :  One  is  for  the  Government  to  give  prizes  or 
bounties  to  couples  that  conform  to  certain  specified  standards  in  the 
same  way  as  the  French  Government  has  encouraged  the  increase  of 
population  by  offering  inducements  to  couples  of  the  poorer  class 
who  raise  seven  or  more  children." 

The  second  is  to  forbid  alliances  among  criminals,  paupers,  and  the 
feeble-minded.     These  classes  fall  under  the  tutelage  of  the  State, 

« In  1889,  fathers  of  seven  children  were  made  exempt  from  payment  of  the 
personal  property  tax.  This  exemption  was  in  1890  limited  to  fathers  who  paid 
taxes  of  not  over  10  francs  each. 


674  REPORT   OF   NATIONAL  CONSERVATION   COMMISSION. 

and  thereby  forfeit  their  right  to  free  choice.  Already  Indiana," 
Connecticut,^  Michigan,''  and  other  States  in  this  country,  have 
passed  laws  of  this  sort. 

Indiana  extends  the  prohibition  to  all  persons  suffering  from  trans- 
missible disease  of  any  sort.  This  prohibition  is  called  into  daily 
operation  in  that  State.  It  is  in  the  power  of  the  Indiana  state  board  i 
of  health  to  raise  by  degrees  the  standards  of  health  demanded  of 
those  who  desire  license  to  marry,  a  provision  that  aims  directly  at 
the  improvement  of  human  vitality  in  the  State.  Indiana  has  gone  i 
even  further  and  has  recently  provided  <*  that  confirmed  criminals, 
imbeciles,  idiots,  and  rapists,  procreation  by  whom  is  deemed  inad- 
visable by  experts,  shall  be  unsexcd  (or  "  sterilized  ")  by  surgical 
operation.  Under  this  law  over  800  prisoners  have  been  sterilized  to 
date.'' 

The  experiments  started  in  Indiana  and  other  States  will  be  inter- 
esting to  watch,  and  promise  an  improvement  over  the  conditions 
which  have  prevailed  too  often  in  the  past.  Professor  Brewer,  of 
Yale,  tells  of  a  case  in  Connecticut  some  years  ago  where  a  feeble- 
minded pauper  woman,  kept  as  a  public  ward,  was  admired  by  a 
half-witted  farmer  living  in  an  adjoining  town.  A  selectman  of 
the  town  maintaining  the  w^oman  "  to  get  rid  of  her  support "  en- 
couraged their  marriage.  His  short-sightedness,  even  from  the  stand- 
point of  immediate  money  economy,  to  say  nothing  of  racial  economy, 
became  apparent  when,  a  few  years  later,  she  and  her  husband  and 
three  idiotic  children  drifted  into  the  poorhouse  of  the  husband's  j 
town. 

That  laws  like  the  ones  discussed,  but  of  gradually  increasing 
severity,  will  become  common  in  the  future  seems  likely;  and,  as 
Professor  Lankester  has  remarked,  humanity  will  probably  submit 
in  the  future  to  communal  restriction  of  the  right  to  multiply  with  as 
good  grace  as  it  has  given  up  the  right  to  rob  and  to  rape.^ 

The  effect  of  restrictions  upon  free  right  of  marriage  is  discussed 
by  Doctor  Hurty,  secretary  of  the  Indiana  state  board  of  health,  as 
follows : 

It  seems  most  essential  and  necessary  that  we  have  laws  for  the  prevention 
of  the  production  of  the  unfit  if  society  is  to  be  saved  from  destruction.  Modern 
hygiene,  under  which  I  include  in  this  instance  all  such  benevolent  institutions 
as  insane  asylums  and  institutions  for  the  feeble-minded,  is  extending  the  dura- 
tion of  life  of  the  dependents  and  deficients,  and  it  might  be  added  that  the 
humane  and  hj^gienic  care  in  the  prisons  is  extending  the  duration  of  life  of  the 
delinquents.  In  Indiana  the  life  duration  of  the  insane  has  been  extended  eight 
years  within  the  last  two  decades.  This  slight  extension  means  a  very  con- 
siderable burden  upon  the  people,  and  if  this  class  of  deficients  is  unrestricted 
we  can  readily  see  what  a  burden  time  will  place  upon  society.  The  production 
of  the  unfit  must  cease  if  charity  and  hygiene  continue.  Otherwise  it  seems 
certain  that  society  will  be  swamped. 

« Indiana  Laws  of  1905,  chap.  126,  H.  US,  sec.  3. 

^Connecticut  Statutes  (revision  of  1902,  sec.  1354),  forbid  the  marriage  of 
epileptics. 

"  Michigan  forbids  the  marriage  of  epileptics. 

<»  Indiana  Law  of  1907,  chap.  215,  H.  364. 

«  Letter  from  Dr.  J.  N.  Hurty. 

^  E.  R.  Lankester,  "The  Kingdom  of  Man,"  London  (Constable),  1907,  p,  41. 

The  recent  report  of  the  Royal  Commission  on  the  Care  and  Control  of  the 
Feeble  Minded  recommends  such  restriction. 


jlSHBB.1  NATIONAL  VITALITY.  675 

While  institutional  treatment  of  the  insane  is  right  and  proper 
rom  a  humanitarian  point  of  view,  by  bringing  an  increase  in  the 
verage  insane  lifetime  it  adds  to  the  public  burden  and  enlarges  the 
igures  of  the  living  insane.  Mr,  Sanborn  estimates  the  average 
Qsane  life  in  Massachusetts  at  thirteen  years,  of  which  at  least  three 
ears  occur,  on  the  average,  before  hospital  treatment  is  applied. 
le  adds: 

I  suspect  we  have  come  nearer  to  statistical  accuracy  on  this  question  In 
Tassachusetts  than  has  been  reached  in  any  region  of  equal  population  any- 
where. The  world  has  been  gradually  coming  round  to  the  conclusions  reached 
y  the  late  Dr.  Pliny  Earle  (of  Northampton)  and  myself,  viz,  that  the  changes 
1  the  social  and  sanitary  conditions  of  all  civilized  countries  have  increased 
ae  number  (proportioned  to  population)  of  new  cases  of  insanity,  while  the 
nproved  treatment  of  patients  in  the  meantime  has  made  the  average  insane 
fe  longer  than  formerly,  and  that  in  spite  of  the  well-known  increase  in  forms, 
ke  paresis  and  epilepsy,  which  may  soon  end  fatally. 

Interesting  records  exist  of  two  families  of  criminals,  the  so-called 
Jukes "  and  the  "  Tribe  of  Ishmael."  From  the  one  man  who 
ounded  the  "Juke"  family  came  1,200  descendants  in  seventy-five 
ears;  out  of  these,  310  were  professional  pauj^ers,  who  spent  an 
ggregate  of  two  thousand  three  hundred  years  in  poorhouses,  50 
jere  prostitutes,  7  murderers,  60  habitual  thieves,  and  130  common 
riminals. 

Dugdale"  has  estimated  that  the  "Juke"  family  was  an  economic 
)ss  to  the  State,  measured  in  terms  of  potential  usefulness  wasted, 
osts  of  prosecution,  expenses  of  maintenance  in  jail,  hospital,  and 
sylums,  and  of  private  loss  through  thefts  and  robberies  of  $1,300,000 
1  seventy-five  years,  or  over  $1,000  for  each  member  of  the  family. 

Similarly,  the  "  Tribe  of  Ishmael,"  numbering  1,692  individuals  in 
LX  generations,  has  produced  121  known  prostitutes  and  has  bred 
undreds  of  petty  thieves,  vagrants,  and  murderers.  The  history  of 
le  tribe  is  a  swiftly  moving  picture  of  social  degeneration  and  gross 
arasitism,  extending  from  its  seventeenth-century  convict  ancestry 
)  the  present-day  horde  of  wandering  and  criminal  descendants.'' 

Had  the  original  criminals  in  the  "  Juke  "  family  and  the  "  Tribe 
f  Ishmael "  been  sterilized  under  some  law  like  that  of  Indiana,  this 
Duntry  would  not  only  have  been  spared  a  widely  disseminated 
riminal,  epileptic,  and  immoral  strain,  but  would  have  saved  hun- 
reds  of  thousands  of  dollars  paid  out  for  criminal  suits  and  for 
istitutional  care,  to  say  nothing  of  the  expenses  still  to  come  from 
le  incapacity  and  criminality  of  future  generations. 

These  cases  present  only  one  side  of  the  case.  Over  against  them 
lay  be  set  illustrious  families  in  which  great  intellectual  ability  and 
loral  worth  have  been  passed  on  through  many  generations.  Such  a 
Qe  is  the  Hohenzollern  family.  In  commenting  on  the  frequent  oc- 
irrence  of  persons  of  surpassing  mental  and  moral  attainments  in 
lis  family,  Woods''  says :  "  It  is  particularly  suggestive  of  what  might 
3  done  with  the  human  race  were  mankind  ever  so  inclined."  A  simi- 
;ir  example  from  a  different  walk  in  life  is  afforded  by  the  Darwin 
^mily,  where  for  four  generations  in  direct  line  (Erasmus,  Charles, 

'«R.  L.  Dugdale:  "The  Jukes,"  New  York  (Putnam),  1877. 

'Oscar  C.  McCulIoch,  "The  Tribe  of  Ishmael,"  a  study  in  social  degeneration, 
Report  of  Fifteenth  Annual  Conference  of  Charities  and  Corrections,  1888," 
?.  154-159. 

"F.  A.  Woods,  "Mental  and  Moral  Heredity,"  New  York    (Holt),  p.  79. 


676  REPORT   OF   NATIONAXi  CONSERVATION   COMMISSION. 

George,  Horace,  and  Francis)  as  well  as  in  collateral  lines  (e.  g. 
Francis  Galton)  Bcientific  ability  of  the  first  rank  has  been  manifest 

President  Roosevelt  has  pointed  out  that  "  race  suicide  "  is  a  sigi 
and  accompaniment  of  coming  decay.  Mere  numerical  increase  ii 
not  the  whole  solution,  however;  there  must  be  improvement  ii 
quality  also.  A  race  that  can  not  hold  its  fiber  strong  and  true  de 
serves  to  suffer  extinction  through  race  suicide.  The  decline  of  oui 
Puritan  stock,  so  well  pictured  in  the  genteel  but  worn-out  Pyncheoi 
family  of  Hawthorne's  novel,  need  not  alarm  us  if  we  can  replace  r 
with  a  new  influx  from  the  West  or  from  the  vigorous  stocks  o; 
Europe. 

There  is  one  problem  which  concerns  both  the  numbers  and  thi 
quality  of  future  generations,  which  hitherto  has  received  practicalb 
no  attention  except  in  a  partial  report  upon  the  subject  in  Australia 
This  problem  is.  What  is  now  and  will  be  the  effect  of  voluntary 
childlessness  upon  the  size  and  character  of  the  birth  rate  and  upoi 
morals?  It  would  be  useless,  here,  however,  to  do  more  than  mentioi 
this  as  one  of  the  gravest  problems  in  the  world  to-day.  Ronald  M 
Byrnes  *  shows  that  the  fecundity  of  Yale  graduates  has  steadih 
diminished  from  5.7  for  the  graduates  of  1701-1791  to  2.0  for  those  o 
1867-18-86.  This  reduction  is  much  greater  than  the  reduction  for  th' 
whole  country,  which  is  reported  by  the  census  to  he  from  5.8  in  179( 
to  4.6  in  1900.  Degenerates  have  large  families.  From  a  study  of  15( 
degenerate  families.  Doctor  Tredgold "  found  that  the  average  num 
ber  of  children  per  family  was  7.3,  while  the  normal  average  for  thi 
country  at  large  (England)  is  4.  These  figures  do  not  specify  th 
frequency  of  marriage  among  degenerates  or  the  mortality.  Unles 
the  OHe  is  sufficiently  low  and  the  other  sufficiently  high,  there  mus 
follow  deterioration.  General  reduction  of  the  birth  rate  may  end  ii 
depopulation.  It  is  not  unlikely  that  this  phenomenon  will  be  thi 
stimulus  needed  to  bring  about  practical  eugenic  reforms. 

What  eugenics  might  possibly  accomplish  is  indicated  by  on 
writer  in  the  following  manner :  "  How  rapidly  the  race  would  ad 
vance  if  mankind  should  resolve :  '  The  next  generation  must  be  bon 
with  healthy  bodies;  must  be  nurtured  in  healthy  phj^sical  and  mora 
environments;  and  must  be  filled  with  the  ambition  to  again  giv( 
birth  to  a  still  healthier,  still  nobler,  generation.'  "  <* 


*  The  Francis  Galtou  Laboratory  for  National  Eugenics.  University  of  Lou 
don,  is  soon  to  issue  a  "  Treasury  of  Human  Inheritance,"  containing  pedigree 
Illustrating  inheritance  of  various  types  of  intellectual  ability,  of  tuberculoa 
stocks,  of  epilepsy,  physical  depravity,  etc. 

^  Yale  Review,  November,  1908. 

"  W.  C.  D.  Whetham,  "  Inheritance  and  Sociology,"  the  Nineteenth  Centurj 
January,  1909. 

^  Louis  R.  Ehrich,  "  Posteritism,"  an  address  delivered  at  the  dedication  ex 
ercises  of  The  Century  Chest,  Colorado  Springs,  Colo.,  1901.  For  literature  oi 
eugenics,  the  reader  is  referred  to  the  following  papers  and  the  references  thereii 
contained :  "  Eugenics,  Its  Definition,  Scope,  and  Aims,"  by  Francis  Galtoi 
American  Journal  of  Sociology,  Vol.  X,  pp.  1-6,  1904.  "  The  Scope  and  Im 
portance  to  the  State  of  the  Science  of  National  Eugenics,"  by  Karl  PearsoE 
Oxford  University  Press,  England.  "  Social  Darwinism,"  by  D.  Collin  Weill 
Papers  and  Proceedings  of  the  American  Sociological  Society,  Vol.  I,  Universit] 
of  Chicago  Press.  "The  Human  Harvest,"  by  David  Starr  Jordan,  Bostoi 
(American  Unitarian  Association),  1907.  "  Eugenics,"  by  Prof.  Albert  G.  Kellei 
Yale  Review,  August,  1908.  "A  First  Study  of  the  Statistics  of  PulmonarJ 
Tuberculosis,"  by  Karl  Pearson,  Drapers  Company,  Research  Memoirs,  Londoi 
(Delau  &  Co.),  1907. 


FISHER.]  NATION  All  VTTALJTT.  677 

Chapter  VII. — Conservation  through  public  hygiene. 
Section  1. — Mnnidpal  hygiene. 

"\Miatever  improvements  in  heredity  may  sometime  be  achieved,  the 
benefits  of  their  influence  can  be  enjoyed  only  by  future,  perhaps  dis- 
tantly future,  generations.  We  of  the  present  generation  have  to  take 
our  heredity  as  we  find  it.  We  can  not  follow  the  advice  of  the  hu- 
morous philosopher  to  begin  life  by  selecting  our  grandparents;  but, 
through  hygiene,  we  can  make  the  most  of  our  inherited  endowment. 
Even  such  a  limited  effort  offers  large — amazingly  large — rewards. 

Ideal  conditions  for  health  comprise  a  pure  and  disease- free  atmos- 
phere in  which  to  live  and  work;  pure  food  and  a  pure  water  supply; 
protection  from  infection  and  accident;  and  a  proper  adjustment  of 
work,  rest,  and  amusement.  Existing  conditions  are  not  only  far 
from  ideal,  but  also  far  from  what  might  easily  and  speedily  be 
attained. 

That  the  savins:  power  of  hygiene  is  great  is  now  universally  recog- 
nized; that  it  will  be  greater  is  the  hope  and  belief  of  those  most 
competent  to  judge.  "  If  hygiene  were  able  to  prolong  life  when  it 
was  little  developed,  as  was  the  case  until  recently,  we  may  well  be- 
lieve that,  with  our  greater  knowledge  of  to-day,  a  much  better  result 
will  be  obtained."  " 

There  is  every  reason  to  believe  that  human  beings  are  as  amenable 
to  cultivation  as  other  animals  and  plants.  Professor  Graves,  of  the 
Yale  Forest  School,  states  that  by  protecting  trees  from  infection 
their  lives  may  often  be  prolonged  a  century.  Domestic  animals  are 
equally  dependent  on  care.  Doctor  McGee  states  that  the  growth  of  a 
colt  may  be  stopped  by  giving  it  alcohol. 

The  methods  of  securing  improvement  in  health  conditions  may  be 
roughly  classified  under  three  groups:  Public  hygiene,  semipublic 
hygiene,  and  personal  hygiene.  The  first  group  refers  to  activities 
of  the  government;  the  second  refers  to  activities  of  the  medical 
■profession  and  institutions  such  as  hospitals,  sanatoria,  schools,  and 
factories,  and  to  voluntary  associations;  the  third  group  deals  with 
the  private  life  of  the  family  and  the  individual.  Each  of  these 
.  three  groups  covers  phases  of  all  three  branches  of  hygiene,  viz, 
the  hygiene  of  environment,  nutrition,  and  activity.^ 

In  this  chapter  we  have  to  deal  with  public  or  governmental 
hygiene.  This  branch  has  been  chiefly  concerned  with  pure  air  and 
pure  food  and  with  organisms  producing  epidemic  diseases.  Boards 
of  health  are  a  recent  invention,  and  in  this  country  they  have  as  yet 
been  only  imperfectly  developed.  They  can  never  become  the  power 
they  should  be  until,  first,  public  opinion  better  realizes  their  use- 
fulness and  the  fact  that  their  cost  to  the  taxpayer  is  saved  many 
times  over  by  the  prevention  of  death  and  disease;  second,  more  and 
better  health  legislation  is  enacted — national,  state,  and  municipal ; 
'  and,  third,  special  training  is  secured  for  what  is  really  a  new  pro- 

»  Metchnikoff,  Prolongation  of  Life,  p.  144. 

*  Since  tliis  report  was  written  tliere  has  appeared  the  excellent  and  inspiring 
"  Civics  and  Health,"  by  William  H.  Allen,  Bureau  of  Municipal  Research,  New 
York  (Ginn),  1909. 


Fi 


678  KEPORT   OF    NATIONAL.  CONSERVATION   COMMISSION. 

fession,  that  of  public  health  officer — a  profession  already  recognized 
in  England  by  a  special  diploma. 

The  health  officer  should  be  supported  entirely  by  the  salary  of  his  office  and 
should  be  absolutely  prohibited  from  practicing  medicine.  Not  only  are  his 
duties  incompatible  with  practice  quite  as  siuch  as  those  of  judges  with  the 
practice  of  law,  but  if  he  gives  them  proper  attention  there  is  no  time  for  other 
duties.  No  court,  police,  or  fire  department,  or  other  agency  of  government, 
can  be  more  important  to  a  people  than  this  under  the  complex  conditions 
incident  to  the  rapid  growth  of  both  rural  and  urban  populations.  It  is  so 
Important  that  this  be  realized  that  it  is  worthy  of  serious  consideration  as  to 
whether  it  would  not  be  better  for  all  imperfectly  equipped  and  supported 
health  boards  in  this  country  to  resign— so  that  the  authorities  and  people 
would  be  brought  face  to  face  with  the  knowledge  that  they  have  no  real  pro- 
tection except  in  the  emergency  of  an  epidemic — than  for  existing  conditions  to 
continue. 

Laboratories,  research  workers,  statisticians,  and  other  facilities  for  the 
performance  of  a  national  board  of  health's  duties  should  be  furnished  in  pro- 
portion to  the  power  and  wealth  of  the  Government  and  the  vast  interests  it 
would  protect  and  promote.  The  results  of  its  scientific  and  collective  investi- 
gations should  be  constantly  utilized  in  promoting  health  in  the  army  and  navy, 
in  protecting  streams  and  soils  from  pollution,  in  the  construction  of  interstate 
waterways,  in  the  reclamation  of  swamp  lauds,  and  in  other  public  works 
involving  health  problems  of  supreme  importance  to  the  future  of  this  country .<• 

Public  hygiene  may  be  studied  under  three  heads,  corresponding  to 
our  governmental  divisions:  Municipal  hygiene,  state  hygiene,  and 
federal  hygiene. 

Municipal  hygiene  and  sanitation  are  placed  largely  in  the  hands  of 
city  boards  of  health,  or  equivalent  organizations,  which  have  power 
to  issue  sanitary  regulations,  abate  nuisances,  and  even  to  punish 
infractions  of  their  instructions  by  fine  and  imprisonment.  Sanitary 
legislation  is  a  product  of  advanced  civilization.  To-day  not  a  city 
is  without  a  board  of  health.  The  powers  of  these  boards  have 
grown,  till  to-day  they  are  by  no  means  inconsiderable;  yet  they 
must  be  given  even  greater  authority,  if  our  municipal  sanitary  con- 
ditions are  to  be  what  they  should.  Public  apathy  and  political 
interference  are  such  that  health  authorities  can  not  enforce  their 
orders.  In  addition  to  the  acquirement  of  greater  power,  city  health 
boards  often  need  purification  of  motive  and  the  banishment  of 
political  bickerings  and  personal  jealousies. 

The  simplest  ordinances  along  the  line  of  public  hygiene  are  those 
against  spitting,  which  now  remain  so  largel;^  unenforced. 

The  smoke  nuisance  is  another  seemingly  simple  form  of  air  vitia- 
tion that  is  receiving  attention  to-day.  Sulphuric  acid  is  apparently 
the  most  injurious  factor.  The  corrosion  of  stone  structures  suggests 
the  irritation  resulting  in  catarrh  and  other  respiratory  mucous- 
membrane  troubles.* 

The  effect  of  the  introduction  of  closed  sewers  on  the  reduction  of 
tuberculosis  should  not  be  overlooked.  By  closing  sewers,  impure 
gases  have  been  confined,  thereby  removing  an  important  source  of 
air  pollution.  Some  cities  realize  that  pure  air  spells  life  and  health 
to  its  inhabitants,  and  that  pure  air  is  a  possibility  only  when  atmos- 
pheric particles  of  soot  and  dirt  are  removed. 

Regulations  governing  garbage  removal,  notification  and  isolation 
of  disease,  and  the  like  are  as  a  rule  enforced,  and  new  regulations 
are  being  issued  constantly.    Substantial  progress  is  shown  each  year 

« Letter  from  Dr.  J.  N.  McCormack. 

'  See  Journal  American  Medical  Association,  September  7,  1907,  p.  813. 


i-iSHKB.]  NATIONAL   VITALITY.  679 

in  the  purification  of  city  water  supplies,  in  the  improvement  of  sew- 
age disposal,  and  in  the  bettering  of  drainage  conditions.  Streets 
are  more  thoroughly  cleaned  and  the  elimination  of  public  and  private 
nuisances  continues  without  ceasing. 

Our  city  streets  have  received  greater  care  since  Colonel  Waring 
organized  his  "  white  wings  "  brigade  in  New  York  City  a  dozen 
years  ago,  thus  proving  the  great  effectiveness  of  clean  streets  in  the 
elimination  of  disease.  The  probable  elimination  of  the  horse  from 
our  city  life,  through  automobiles,  tlie  betterment  of  our  trolley  sys- 
tems, and  the  introduction  of  subways  (especially  freight  subways) 
will  go  far  to  improve  our  city  atmosphere.  The  problem  of  city  air 
will  be  half  solved  when  our  streets  reach  their  proper  state  of  clean- 
liness. The  gradual  elimination  of  the  horse  will  tend  not  only  to 
produce  cleaner  air,  but  also  to  reduce  the  dangers  from  flies.  It  is 
in  horse  manure  that  the  common  housefly  ("  typhoid  fly  ")  chiefly 
breeds.  Doctor  Howard  attributes  the  termination  of  typhoid  in 
certain  parts  of  Washington  to  the  displacement  of  the  horse  by  the 
automobile. 

Only  within  a  dozen  years  has  the  dread  importance  of  insect  car- 
riers of  disease  been  realized.  That  mosquitoes  carry  malarial  germs ; 
that  flies  are  the  propagators  of  typhoid,  cholera,  and  other  infectious 
diseases ;  that  rats  breed  the  fleas  which  transmit  to  man  the  dreaded 
Asiatic  plague  * — all  this  knowledge  is  of  recent  origin.* 

Well  people  are  sometimes  carriers  and  distribute  typhoid,  diph- 
theria, etc.,  a  fact  which  complicates  public-health  regulations. 

The  simple  reporting  of  all  contagious  disease  to  the  health  au- 
thorities immediately  on  its  appearance  is  often  the  means  of  prevent- 
ing an  epidemic. 

Smallpox  epidemics  are  prevented  both  by  quarantine  and  vacci- 
nation. Because  of  the  outcry  against  compulsory  vaccination,  in  some 
places  the  responsibility  for  vaccination  is  being  thrown  upon  the 
individual.  This  is  true  in  Leicester,  England,  and  in  Minnesota. 
Doctor  Bracken,  secretary  of  the  Minnesota  State  Board  of  Health, 
writes  that  since  the  quarantine  has  been  abandoned  and  the  indi- 
vidual has  had  the  option  of  being  vaccinated  or  not,  a  larger  number 
has  been  vaccinated  and  smallpox  has  diminished. 

We  are  awaking  to  the  importance  of  securing  for  ourselves, 
through  our  city  health  agencies,  a  pure  milk  supply.  Great  danger 
is  also  present  in  cream,  butter,  cheese,  and  ice  cream.  More  than  one 
city  has  inaugurated  a  policy  of  careful  supervision  of  the  milk  sup- 
ply. Montclair,  N.  J.,  has  a  well-considered  plan  in  operation 
whereby  the  bacterial  count  of  each  dairy  is  public  to  inquirers  at 
the  board  of  health.  This  species  of  publicity  will  some  day  prove  a 
strong  incentive  to  a  better  milk  supply.  Some  cities  have  even  estab- 
lished municipal  stations,  where  during  the  summer  season  sanitary 
milk  may  be  purchased  at  cost.  Doctor  Goler,  of  Rochester,  has  em- 
phasized the  fact  that  "  We  employ  physicians  to  cure  children  af- 

•  See  Rupert  Blue,  "  The  prophylaxis  and  eradication  of  plague,"  California 
State  Journal  of  Medicine,  Vol.  V,  1907,  p.  304. 

*A  full  treatment  of  the  subject  of  insect-borne  disease  has  been  prepared 
by  Dr.  L.  O.  Howard,  Chief  of  the  Bureau  of  Entomology  of  the  Department  of 
Agriculture,  for  the  National  Conservation  Commission.  See  also  Charles  Har- 
Mngton,  M.  D.,  "Practical  Hygiene,"  Third  Edition,  Philadelphia  (Lea),  1905, 
pp.  637-G60. 


680  REPORT   OF   NATIONAL  CONSERVATION   COMMISSION. 

fected  by  the  diarrheal  diseases  from  dirty  milk,  while  we  permit  the 
sale  of  dirty  milk  from  filthy  cattle."  « 

In  Rochester,  through  the  efforts  of  Doctors  Goler  and  Roby,  a  few 
municipal  milk  stations  were  established  in  1897,  where  during  July 
and  August  milk  in  nursing  bottles  could  be  bought  at  a  low  price. 
The  reduction  in  the  Rochester  infant  death  rate  between  1897  and  ; 
1906  is  doubtless  due  to  many  other  conditions  than  the  quality  of 
milk ;  but  the  special  attention  drawn  to  the  milk  supply  and  the  con- 
sequent education  of  the  public,  which  probably  boiled  its  milk  when 
it  could  not  get  it  clean,  would  explain  a  considerable  part  of  the 
reduction.* 

The  interrelation  of  the  purity  of  milk  supply  and  infant  mortality 
is  shown  by  the  following  excerpt  from  Doctor  Woodward's  annual 
report  as  health  officer  of  the  District  of  Columbia  for  the  year  1907: 

High  as  is  the  infantile  mortality  even  now  from  diarrhea  and  inflammation 
of  the  bowels,  it  is  far  below  the  figures  that  formerly  prevailed. 

The  only  explanation  for  the  fall  in  the  death  rate  from  infantile  diarrhea 
that  I  have  been  able  to  discover  is  the  enactment  on  March  2,  1895,  of  the  law  j 
regulating  the  sale  of  milk  in  this  District  and  the  establishment  of  dairy  and  ! 
dairy-farm  inspection  under  the  provision  of  that  law.  , 

The  weekly  report  of  the  Cincinnati  board  of  health  for  August 
21,  1908,  states: 

,  As  far  as  we  know,  there  has  been  but  one  death  among  the  babies  whose  food 
supply  has  been  obtained  from  the  milk  stations.  When  it  is  taken  into  con- 
sideration the  large  number  of  children  we  have  supplied,  this  statement  is 
certainly  a  fitting  commentary  upon  the  value  of  a  bacteria-free  and  chemically 
pure  milk. 

At  the  recent  International  Congress  on  Tuberculosis,  one  delegate 
reported  an  experiment  in  England  which  has  not  yet  appeared  in 
print.  In  Liverpool  the  local  government  board  tried  the  experiment 
of  using  pasteurized  milk.  The  amount  of  illness  and  death  in  that 
city  from  children's  tuberculosis  is  very  great,  yet  among  1,800  chil- 
dren who  were  given  pasteurized  milk  and  who  were  carefully 
watched  every  week  not  a  single  case  of  tuberculosis  developed, 
which  seems  to  prove  conclusively  that  children's  tuberculosis  is  en- 
tirely preventable  by  the  use  of  pure  or  pasteurized  milk.  This  is 
interesting,  though  at  variance  with  former  opinion  regarding  bovine 
tuberculosis  in  children. 

In  this  section  should  also  be  mentioned  such  municipal  health 
agencies  as  public  baths,  bacteriological  laboratories,  and  the  dis- 
tribution and  administration  of  specific  antitoxin,  vaccine,  and  free 
medical  service.  Municipal  inspection  of  local  abattoirs  is  also  im- 
portant, inasmuch  as  federal  inspection  covers  only  establishments  i 
engaged  in  interstate  business. 

Most  important  of  all  is  the  matter  of  preventing  pollution  of  the  i 
water  supply  of  cities,  a  topic  that  will  receive  fuller  treatment  later 
in  the  chapter. 

«  See  George  W.  Goler,  M.  D.,  "  Municipal  regulation  of  the  milk  supply," 
paper  at  the  meeting  of  the  American  Medical  Association,  1007,  p.  2.  For  con- 
clusions based  on  a  study  of  330  milk-borne  epidemics,  see  George  M.  Ko- 
ber,  M.  D.,  "Milk  in  relation  to  public  health,"  S.  Doc.  No.  441,  Government 
Printing  Office,  1902. 

^  See  George  W.  Goler,  M.  D.,  "  Origin,  development,  and  results  of  municipal 
milk  work  in  Rochester,  N.  Y.,"  Maryland  Medical  Journal,  June,  190G. 


ISHEB.]  NATIONAL  VITALITY.  681 

The  needs  of  municipal  as  of  state  hygiene  are  not  so  much  new 
aws  as  better  men  to  enforce  existing  laws  and  an  aroused  public 
pinion  that  will  result  in  the  appropriation  of  funds  sufficient  to 
nable  health  authorities  to  perform  their  duties  in  an  efficient  man- 
er.  Larger  appropriations  will  doubtless  bring  better  men  into  the 
'ublic-health  service. 

Section  2. — State  hygiene. 

\  State  hj^giene  is  necessary  to  supplement  municipal  hygiene  for 
lany  reasons.  One  is  that  the  country  often  has  no  other  sort  of 
mitation  possible.  Another  is  that  the  city  is  dependent  on  the 
Duntry  for  its  water,  milk,  and  other  supplies.  Dr.  W.  G.  Daggett, 
f  New  Haven,  has  emphasized  the  fact  that  in  origin  typhoid  is 
irgely  a  rural  disease  and  must  be  combated  by  controlling  rural 
rivies  and  other  sources  of  infection.**  A  competent  authority  as- 
jrts  that  "  old  country  wells,  so  much  valued  by  their  owners,  are 
positive  menace  to  public  health.  Fully  50  per  cent  of  these  are 
nfit  for  use."  Much  of  the  typhoid  fever  brought  by  milk  is  readily 
aceable  to  such  wells. 

In  the  control  of  the  liquor  traffic  the  State  and  local  units  should 
Doperate.* 

A  state,  rather  than  a  municipal,  function  is  the  regulation  of 
oman  labor  and  child  labor.  The  growth  of  public  opinion  on  this 
oint  has  been  rapid.  In  order  to  make  the  working  hours  meet 
le  physiological  requirements  of  women,  two  special  conditions 
lould  be  attended  to.  One  is  her  monthly  period ;  the  other  is  child- 
saring.  The  neglect  of  both  is  responsible  not  only  for  physical 
npairment  of  factory  women,  but  also  for  their  inability  to  perform 
leir  functions  as  mothers  of  the  race.  Doctor  Stiles,  of  the  Public 
[ealth  and  Marine-Hospital  Service,  has  suggested  a  very  sensible 
jmedy  to  meet  the  first  of  these  conditions,  and  one  which  has  met 
ith  the  approval  of  many  factory  employers.  It  is  that  each  woman 
lall  have  the  right,  once  every  month,  to  walk  out  of  the  factory 
ithout  any  questions  being  asked,  and  without  loss  of  the  day's 
ages.  The  matter  is  further  simplified  in  factories  provided  with  a 
atron  and  a  rest  room.  In  respect  to  the  second  condition — that  of 
lildbearing — the  evidence  is  clear  and  convincing.  Women,  on 
jcount  of  their  imperfectly  developed  muscular  system  and  more 
ilicate  physique,  are  unfitted  for  hard  work;  nor  should  they  be 
)liged  to  work  steadily  in  a  sedentary  position,  especially  at  the  sew- 
ig  machine,  or  other  occupations  involving  the  use  of  the  lower 
ctremities.  Special  protection  should  be  extended  to  them  during 
le  childbearing  period.  It  is  a  matter  of  constant  observation  that 
omen  who  have  to  deny  themselves  proper  rest  and  care  during  the 
ixt  six  weeks  after  confinement  are  very  liable  to  suffer  from  hemor- 
lages  and  chronic  uterine  diseases,  while  miscarriages  and  prema- 
je  births  are  not  infrequent  results  of  overwork.'' 

•^  "  The  prevention  of  typhoid  fever,"   Proceedings  Connecticut  Medical   So- 
jty,  New  Haven. 

''  See  "  Regulation  of  the  liquor  traffic,"  Annals  American  Academy  of  Political 
id  Social  Science,  November,  1908. 

'^  George  M.   Kober,  M.  D.,  "  Industrial  and  personal  hygiene,"  "  Report  of 
)mmittee  on  Social  Betterment  of  the  President's  Homes  Commission,"  Wash- 
!  Elton.  1908,  pp.  67-68. 


682  REPORT   OP    NATIONAL  CONSERVATION   COMMISSION. 

The  employment  of  mothers  shortly  before  and  after  the  time  of 
childbirth  is  prohibited  in  a  number  of  European  countries.  Ameri- 
can statutes,  however,  are  almost  silent  on  the  question."  Professor 
Jevons  went  so  far  as  to  advocate  the  enactment  of  legislation  forbid- 
ding the  employment  of  mothers  till  their  youngest  children  were  at 
least  3  years  old.  j 

The  beneficial  effect  on  the  mother,  and  especially  on  the  child,  of 
forbidding  the  factory  to  her  just  before  and  after  childbirth  has 
been  proved  many  times.  The  case  of  M.  Dollfus,  a  large  employer 
of  women  at  Mulhausen,  in  Alsace,  has  been  repeatedly  cited.  He 
required  mothers  to  remain  away  from  their  work  for  a  period  of 
six  weeks  after  childbirth,  during  which  time  he  paid  them  full 
wages.  The  decrease  in  infantile  mortality  in  the  first  year  of  the^ 
experiment  was  from  more  than  40  to  less  than  18  per  cent.^ 

The  waste  of  vitality  from  unphysiological  hours  of  work  is  most 
striking  in  the  case  of  children.  It  is  hardly  to  be  questioned  that 
children  need  longer  hours  of  rest  and  sleep  than  adults,  and  that 
their  immature  bodies  are  much  closer  to  the  fatigue  limit.  A  little 
girl  in  a  southern  mill  replied  to  Mrs.  Van  Vorst's  query  whether  she 
were  often  tired,  "  AVhy,  I'm  always  tired."  Except  in  unusual  cases 
and  for  limited  periods,  child  factory  labor  can  not  be  defended  on 
any  hygienic  grounds.  The  period  of  preparation  for  a  wholesome, 
healthy  life  should  be  left  free  from  the  cares  and  evil  physical  in- 
fluences of  factory  life.  No  child  should  run  the  risk  of  serious  acci- 
dent, deformity,  dwarfing,  or  mental  stunting  through  factory  labor. 
It  is  true  that  in  the  South  child  labor  is  often  the  lesser  of  twc 
evils,  the  other  being  the  life  on  a  farm  where,  through  soil  pollu- 
tion, the  child  contracts  hook-worm  disease.  Here  the  abolition  oi 
child  labor  should  be  preceded  by  the  abolition  of  hook-worm  disease.' 

Closely  connected  with  the  restriction  of  child  and  woman  laboi 
is  factory  legislation  in  general,  dealing  with  hours  of  labor,  factory 
hygiene  and  sanitation,  and  dangers  from  industrial  accident. 

The  hours  of  labor  have  for  a  century  been  on  a  gradual  decrease 
A  hundred  years  ago  fourteen  and  fifteen  hours  were  by  no  means  un- 
common. The  first  public  action  regarding  hours  of  labor  was  taker 
by  President  Van  Buren  in  1840,  when  he  set  ten  hours  as  the  limii 
of  the  working  day  in  all  government  establisliments.  Thirty  year; 
later  this  was  lowered  by  Congress  to  eight  hours.  Since  1850  th< 
fight  has  been  waged  for  a  shorter  day,  both  by  labor  unions  anc 
individuals;  and  the  statutes  of  nearly  all  States  contain  legislatioi 
limiting  the  working  hours  of  women  and  children  in  all  industries 
as  well  as  of  all  workers  in  certain  industries,  especially  mining,  rail 
roading,  and  the  more  dangerous  manufacturing  industries.  Th 
Aldrich  report  of  1890  ^  estimated  that  the  American  working  da^^ 
averaged  eleven  and  four-tenths  hours  in  1840  and  ten  hours  in  18O0 
Tables  based  upon  annual  reports  of  the  Bureau  of  Labor  show  ! 
reduction  of  about  4  per  cent  from  1890  to  1903,«  while  it  is  th 

"John  Spargo,  "The  Bitter  Cry  of  the  Children,"  New  York  (Macmillan) 
1906,  pp.  44-45. 

''  Spargo,  loc.  cit,  pp.  50-51. 

"  See  "  Report  of  the  Surgeon-General  of  the  Public  Health  and  Marint 
Hospital  Service  for  1907,"  relating  to  the  investigations  of  Doctor  Stiles. 

*"  Report  on  Wholesale  Prices  and  Wages,"  1890,  Vol.  I,  p.  178. 

•T.  S.  Adams  and  Helen  L.  Sumner,  "Labor  Problems,"  New  York  (Macmi 
Ian),  1905,  pp.  51G-518. 


nsnBR.]  NATIONAL  VITALITY.  683 

opinion  of  United  States  Commissioner  of  Labor  Neill  that  the 
figures  for  1908  would  unquestionably  be  lower  than  for  1908,  as  the 
straggle  for  the  shorter  working  day  has  been  making  steady  prog- 
ress each  year." 

The  frightful  losses  of  life  and  efficiency  from  preventable  acci- 
dents can  be  prevented  only  by  state  legislation.* 

Our  emploj-er's  liability  acts  are  very  unsatisfactory,  because  they 
fix  no  scale  of  compensation  for  injuries,  but  necessitate  expensive 
lawsuits  to  determine  in  each  case  the  sum  due.  A  president  of  an 
insurance  company  doing  a  large  business  in  employer's  liability 
insurance  states  that  of  the  sums  they  pay  employers  only  one-quarter 
reaches  the  injured  employee,  who  is  forced  to  spend  the  other  three- 
fourths  in  litigation.  In  England  the  workman's  compensation  acts 
have  substituted  a  system  of  specific  sums  for  which  the  employer  is 
liable.  Not  only  does  this  result  in  larger  indemnities  reaching  the 
injured,  because  suits  are  ordinarily  unnecessary,  but  it  has  the  fur- 
ther beneficial  effect  of  reducing  the  number  of  accidents  by  inducing 
employers  to  instal  safety  devices. 

The  regulation  not  only  of  the  place  of  work,  but  also  of  the  dwelling 
place,  has  come  to  demand  action  on  the  part  of  the  State  as  well 
[is  of  the  community.  The  growth  in  tenement-house  legislation  dur- 
ng  the  past  ten  years  has  been  most  encouraging.  Standards  of 
'sanitation  for  our  large  buildings  have  been  raised;  provision  is  in- 
:;reasingly  made  for  good  light,  air,  water,  and  for  protection  from 
^ire;  and  the  "rookeries"  of  old  are  giving  way  to  improved  tene- 
ments.    Yet  New  York  City  still  contains  300,000  rooms  without  a 

ivindow." 

Section  3. — Federal  hygiene. 

The  regulation  of  disease  has  increasingly  become  a  national  func- 
tion.    The  exclusion  of  inmiigrants  with  infectious  diseases  is  only 
Dne  instance  of  this;  another  is  the  work  of  our  Public  Health  and 
Alarine-Hospital  Service,  which  not  only  regulates  the  spread  of  dis- 
'ase  from  State  to  State,  and  regulates  by  quarantine  the  entry  of 
disease  from  without  the  country,  but  also  assists  local  health  boards 
n  their  fights  against  epidemics  and  disease  scourges.     Epeciaily  is 
his  true  in  coastal  cities.     The  Marine-Hospital  Service  assistedNew 
Orleans  to  eliminate  yellow  fever  and  San  Francisco  to  rid  itself 
)f  bubonic  plague.     In  addition,  this  service  treats  50,000  seamen 
)f  the  merchant  marine  each  year,  conducts  a  large  number  of  hos- 
pitals and  relief  stations,  examines    pilots,    life-saving  crews  and 
•evenue-service  men,  and  conducts  a  well-equipped  hygienic  labora- 
ory. 

Federal,  state,  and  municipal  sanitatio^^.  are  all  concerned  with  the 
lygiene  of  transportation.  To-day  almost  the  whole  American  pub- 
ic travels,  and  it  is  therefore  most  important  that  the  conveyances 

»  See  Bulletin  of  the  Bureau  of  Labor,  No.  77,  July,  1908,  pp.  6-7 ;  also,  "  First 
Lnnual  Report  on  Changes  in  Rates  of  Wages  and  Hours  of  Labor  in  Massachu- 
tetts,"  Boston,  1908,  pp.  592-3. 

*The  Federal  Government  can  of  course  reach  interstate  railways.  A  law 
)assed  during  the  last  session  provided  for  a  safe  locomotive  ash  pan.  Previous 
aws  provide  for  autonintie  couplers,  air  brakes,  etc. 

"  A.  Jacobi,  M.  D.,  "  The  physicai  cost  of  women's  work,"  Charities,  February 
;  1907. 

S.  Doc.  419,  61-2—5 


684  BEPOKT    OF    NATIONAL  CONSERVATION    COMMISSION. 

which  they  occupy,  whether  carriage,  cab,  street  car,  or  railway  train, 
shall  be  sanitary  in  respect  to  ventilation,  cleanliness,  toilet  facilities, 
spittoons,  dust,  smoke,  sleeping-car  accommodations,  and  the  like. 
In  smoking  cars,  in  addition  to  the  smoke  itself,  the  floors  are  usually 
iDefouled  with  tobacco  juice  and  other  expectoration.  The  efficient 
remedy  here  as  elsewhere  is  to  be  found,  not  simply  m  providing 
facilities  for  cleanliness,  but  in  fostering  the  present  public  sentiment 
against  spitting  and  other  untidy  habits.  A  physician  of  experience 
maintains  the  opinion  that  "  foul  air  in  railway  trains  and  street 
cars  is  the  cause  of  serious  poisonings  called  '  colds '  and  '  grip,'  par- 
ticularly in  those  many  trains  where  air  from  the  smoker  sweeps 
through  passenger  cars." 

The  development  of  our  national  quarantine  methods  is  indicated 
in  the  following  paragraph  from  Surgeon-General  Wyman,  of  the 
Public  Health  and  Marine-Hospital  Service: 

Until  1893  there  was,  properly  speaking,  no  national  system  of  quarantine. 
The  colonies  had  their  own  quarantine  regulations  before  the  formation  of  the 
Union,  and  from  that  event  to  1S9.3  quarantine  was  left  to  the  care  of  state 
governments  and  by  the  latter  to  county  governments  or  to  municipalities,  as 
the  case  might  be.  There  was,  indeed,  national  legislation,  but  all  the  acts 
of  Congress  up  to  1893  relating  to  quarantine  specially  provided  that  the  said 
national  measures  were  in  aid  of  the  state  and  local  authorities.  Whatever 
opinions  may  have  been  held  by  members  of  the  national  legislature,  quarantine 
was  permitted  to  be  exercised  by  the  States  as  a  police  function,  and  even  in 
the  present  law,  which  gives  national  supremacy,  it  is  iirovided  that  assistance 
shall  be  given  the  States  or  municipalities  by  the  government  authorities,  the 
supremacy  of  the  latter  being  asserted  only  when  the  state  or  local  authorities 
fail  or  refuse  to  enforce  the  uniform  national  regulations.<* 

To-day  efficient  inspection  at  our  various  ports  of  entry  and  at  1 
disembarking  stations  abroad  keeps  out  many  cases  of  disease  each 
year,  while  the  quarantine  cordon  thrown  around  ports  or  municipal 
quarters   affected  by   infectious   disease  is   an   important   factor   in 
stamping  out  such  disease. 

Federal  meat  inspection  chiefly  benefits  the  foreigner,  but  the  ad- 
ministration of  the  pure- food  laws  is  of  value  to  our  own  people. 

There  are  two  functions  of  Federal  Government  which  now  are 
very   imperfectly  served  and  which  might  be  made  of  paramount 
importance.     They  are  the   functions  of  research  and   of  the   dis-    . 
semination  of  information.     A  poultry  raiser,  or  a  cattleman,  or  a   j 
farmer  can  secure  scientific  information  to  guide  him  in  his  selections  i 
of  fowl,  or  stock,  or  seed  by  applying  to  the  Government  at  Washing- 
ton, but  information  on  how  to  raise  children  has  up  to  this  time  been 
neglected  by  our  Government.     Nothing  is  to-day  more  significant  of 
future  progress  than  the  fact  that  the  President,  the  President-elect, 
and  many  Congressmen  are  so  strongly  in  favor  of  a  greater  federal 
organization  of  health.     Through  the  dissemination  of  information 
throughout  the  country,  tlirough  enactment  and  administration  of 
effective  regulations  concerning  pure  food,  inspection  of  meat,  and 
exclusion  of  foreign  diseases,  through  research,  statistics,  and  through  jJ 
better  standards  for  state  and  municipal  health  service,  a  great  econ-  " 
omy  of  national  vitality  can  be  effected.     Washington,  our  national 
capital,  might  be  made  by  the  Federal  Government  a  model  cit}^  of 

« Walter  Wyman,  M.  D.,  "  The  quarantine  system  of  the  United  States," 
The  Sanitarian,  November,  1897,  p.  3.  See  also  James  W.  Garner,  "  Federal 
activity  ia  the  interest  of  the  public  health,"  Yale  Review,  1905-6,  p.  181. 


FISHEB.1  NATIONAli  VITALITY.  685 

healthfulness,  as  a  preliminary  to  its  becoming  a  mo(lel  in  every 
otlier  way. 

Army  hygiene  in  time  of  war  is  most  important.  The  lack  of  such 
hygiene  has  shown  grave  consequences.  In  the  Boer  war  the  British 
army  in  South  Africa  lost  more  men  from  typhoid  fever  than  from 
wounds  received  in  battle." 

The  efficiency  of  Japanese  hygiene  manifests  itself  in  the  fact  that 
General  Oku's  army  of  75,000  during  the  recent  Russo-Japanese  war 
had  but  187  typhoid  fever  cases  in  a  seven  months'  active  campaign. 

The  Japanese  reduced  their  dysentery  cases  from  12,052  in  the 
Chinese  war  to  6,624  in  the  Russian  war;  their  cholera  cases  from 
7,667  to  none;  and  their  malaria  cases  from  41,734  to  1,257.  This  was 
in  spite  of  the  fact  that  their  army  in  the  Russian  war  was  three 
times  tlie  size  of  that  employed  in  the  Chinese  war.** 

The  crying  need  of  better  statistics  is  trenchantly  expressed  by  Dr. 
Cressy  L.  Wilbur,  Chief  of  the  Division  of  Vital  Statistics  of  the  Cen- 
sus Bureau,  whose  words  should  be  read  and  pondered  by  everyone 
who  desires  to  see  any  intelligent  conservation  of  our  vital  resources: 

Sound  vital  statistics  are  the  indispensable  basis  of  modern  sanitation.  A 
nation  that  does  not  consider  it  necessary,  or  tliat  is  not  able,  to  provide  ade- 
quate means  for  registering  the  births  of  its  own  children,  or  for  otiicially 
recording  the  deaths  of  its  citizens,  can  hardly  be  supposed  to  attach  sufficient 
value  to  human  life  to  enable  sanitary  measures  for  its  conservation  to  be  ade- 
iquately  carried  out. 

1  For  the  continental  United  States  in  1907  somewhat  less  than  one-half  of  the 
,total  population  (48.8  per  cent)  was  represented  in  the  registration  area  from 
which  returns  of  deaths  were  received  by  the  Bureau  of  the  Census.  For  the 
remaining  51.2  per  cent  of  the  total  population  of  the  United  States,  estimated 
at  43,774,724  persons,  either  very  imperfect  laws  were  in  effect,  giving  only 
p.irtial  registration,  quite  worthless  for  statistical  purposes,  or  else  the  condi- 
tions in  many  States  might  be  represented  by  the  statement  made  by  one  of 
tlii'ir  health  officers,  that  it  buries  its  dead  people  with  no  more  ceremony  than 
it  buries  its  dead  dogs. 

As  for  the  registration  of  births,  a  measure  which  is  so  supremely  Important 
for  the  knowledge  of  infant  mortality,  for  the  protection  of  infant  life,  and  for 
.securing  the  legal  rights  of  children,  not  a  single  State  in  the  Union  nor  a  single 
city  of  any  considerable  size  makes  positive  claim  that  it  registers  as  many  as 
nine  births  out  of  every  ten  that  occur.  Even  the  city  of  Washington,  whose 
law  for  this  purpose  is  a  direct  enactment  of  Congress,  does  not  arise  above 
this  low  limit  of  efficiency.  The  total  number  of  births  must  be  known  before 
one  can  make  a  computation  of  infant  mortality  which  will  be  comparable  with 
the  rates  given  in  the  vital  statistics  of  all  civilized  nations  except  the  United 
'States.  This  ratio  depends  upon  the  comi)arison  of  deaths  of  infants  under  1 
year  of  age  with  total  births,  and,  as  we  have  no  exact  registration  of  births, 
we  can  not  present  these  important  statistics. 

In  the  consideration  of  the  effect  of  such  an  important  disease  as  tuberculosis 
upon  the  people  of  the  United  States  there  is  no  means  of  knowing,  within  a 
very  wide  margin  of  error,  exactly  how  many  persons  die  from  this  cause  In 
this  country  during  any  year.  We  have  registration  of  deaths  for  about  one- 
half  of  the  population  only,  and  the  very  dissimilar  conditions  of  life  and  the 
large  proportion  of  colored  population  in  the  unregistered  half  seriously  inter- 
fere with  any  attempts  to  guess  at  the  exact  number.  Estimates  have  varied 
from  138,000  to  200,000.  The  truth  probably  lies  somewhere  between  them,  but 
we  certainly  ought  to  have  an  exact  record  of  the  facts  and  not  be  obliged  to 
depend  upon  mere  guesswork  in  entering  upon  an  important  sanitary  under- 
taking, such  as  the  prevention  of  tuberculosis. 

<•  Ditman,  loc.  cit,  p.  17. 

''L.  L.  Seaman,  "The  Real  Triumph  of  Japan,"  New  York  (Appleton),  1906, 
pp.  106-7. 

On  the  question  of  army  diet,  see  Blackham :  British  Medical  Journal,  1908, 
August  8,  p,  311. 


686  BEPORT   OF   NATIONAL  CONSERVATION    COMMISSION. 

We  are  laboring,  In  conjunction  with  the  American  Medical  Association,  the 
American  Public  Health  Association,  and  with  the  sanitary  ofRcials  of  as  many 
States  as  we  can  interest,  to  extend  the  registration  area  as  rapidly  as  possible. 
Ohio  has  just  adopted  an  excellent  law,  which  takes  effect  next  year.  Not  a 
single  State  in  the  South  has  yet  succeeded  in  reachiii?^  a  satisfactory  stand- 
ard— not  one  of  them  in  fact  has  even  passed  an  adequate  law.  We  are  de- 
pendinj;  upon  the  volunlnry  cooperation  of  the  States.  The  Government  has  no 
power,  it  would  seem,  to  collect  the  statistics  or  to  secure  the  proper  registration 
of  births  and  deaths  by  its  direct  action.  If  all  of  the  important  interests  in- 
volved could  be  awakened  to  the  importance  of  this  matter,  if  Congress  would 
take  a  direct  interest  in  the  accomplishment  of  this  work,  we  could  secure  fairly 
complete  registration  of  deaths  for  the  United  States  within  the  next  ten  years.<* 

Chapter  VIII. — Conservation  through  seTnipuhlic  hygiene. 
Section  1. — Medical  research  and  instruction. 

By  semipublic  hygiene  is  meant  hygiene  through  nongovernmental 
institutions,  inchiding  inslilutions  for  medical  research,  the  medical 
profession,  hospitals,  sanatoria,  associations,  schools,  and  factories. 

Medical  discoveries  have  usually  been  made  in  the  laboratories  of 
medical  schools,  universities,  and  research  institutions.  The  practical 
value  of  these  institutions  is  only  beginning  to  be  appreciated.  The 
benefits  ab-eady  received  from  them  are  great,  and  the  benefits  to  come 
will  be  incomparably  greater.  One  of  the  earliest  medical  labora- 
tories, the  Pasteur  Institute  of  Paris,  has  done  splendid  work  during 
the  past  two  decades  in  the  study  of  harmful  and  beneficent  bacteria. 
Of  more  recent  origin  are  the  British  Sanitary  Institute  in  London, 
the  Rockefeller  Institute  for  Medical  Research,  the  Memorial  Insti- 
tute for  Infectious  Diseases  at  Chicago,  and  the  Nutrition  Research 
Laboratory  in  Boston,  under  the  Carnegie  Institute  of  Washington. 
The  recent  achievement  of  Dr.  Simon  Flexner  in  finding  a  serum  for 
the  treatment  of  meningitis  is  but  one  example  of  what  well-directed 
research  under  the  auspices  of  such  institutions  can  accomplish.  The 
crowning  achievement  of  science  in  the  present  century  should  be, 
and  probably  will  be,  the  discovery  of  practical  methods  of  making 
human  life  healthier,  longer,  and  happier  than  heretofore. 

The  medical  schools  in  this  coimtry  number  156.    They  are  rapidly 
advancing,  although  the  great  majority  are  still  ill  equipped  for  pro- 
viding intending  practitioners  with  the  most  recent  and  useful  knowl- 
edge.   The  future  practice  of  medicine  depends  more  on  the  character 
and  aims  of  the  medical  schools  of  to-day  than  on  any  other  factor, 
At  the  dedication  of  the  Harvard  medical  buildings  in  190G,  President 
Eliot  laid  down  as  the  primary  duties  of  that  school  the  study  of  the 
prevention  of  disease  and  the  education  of  the  public.    The  need  of 
such  a  school  especially  devoted  to  prevention  has  been  fully  dis- 
cussed by  Doctor  Ditman.^     Several  universities  liave  courses,  or  are  i 
taking  steps  to  give  courses  in  the  fields  not  only  of  public  hygiene  5 
and  preventive  medicine,  but  also  of  personal  hygiene   and   home  | 
economics. 

•Letter  from  Dr.  Cressy  L.  Wilbur,  See  also  Irving  Fisher,  "Mortality  sta- 
tistics of  the  I'nited  States  census,"  publication  of  the  American  Economic, 
Association,  189!);  and  R.  Dudfield,  "A  critical  examination  of  the  methods  ofi 
recording  and  publishing  statistical  data  bearing  on  public  health,"  Journal  of 
the  (Royal)  Statistical  Society,  March,  1905. 

*  See  N.  E.  Ditnian,  M.  D.,  "  Education  and  its  economic  value  in  the  field  of 
preventive  medicine,"  Columbia  University  PresSj  Vol.  X,  supp.  to  No.  3,  June^ 
1908. 


i 


nsHEE.]  NATIONAL.  VITALITY.  687 

One  difficulty  in  establishing  such  a  school  is  the  lack  of  students 
who  can  atl'ord  tlie  means  or  the  time  to  attend.  This  was  the  ex- 
perience of  the  George  Washington  University,  in  Washington,  when 
a  course  of  this  kind  was  offered.  For  tliis  reason  it  is  gratifying  to 
see  that  an  effort  is  being  made  to  throw  open  the  research  laboratory 
of  the  Public  Health  and  Marine-Hospital  Service  for  the  use  of 
health  officers  detailed  from  their  several  States  and  municipalities. 
In  England  the  degree  of  D.  P.  H.  (diploma  in  public  health)  is  given 
those  who  meet  the  high  standard  set  there  for  health  officers. 

During  the  last  few  years  the  American  Medical  Association  has 
been  seeking  to  study,  classify,  and  improve  the  medical  schools  in 
the  United  States.  A  large  conmiittee,  of  which  the  writer  is  one 
member,  has  been  appointed  by  the  association  to  consider  methods 
of  securing  such  improvements  as  are  deemed  necessary.  It  includes 
in  its  scope  the  important  but  heretofore  little  appreciated  field  of 
medical  economics. 

Section  2. — The  medical  profession. 

We  come  next  to  the  part  played  by  physicians,  so  far  as  relates  to 
their  "  private  practice.''  Their  work  as  public  health  officers  has 
already  been  mentioned,  and  does  not  concern  us  here.  Their  Avork 
in  the  home  is  of  primary  importance.  It  is  on  the  physician  that  the 
average  man  relies  for  protection  wdien  he  finds  himself  in  the  dread 
grip  of  disease. 

Private  practice  comprises  two  main  divisions,  surgery  and  gen- 
eral ])ractice.  The  first  important  application  of  the  knowledge  of 
germs  was  to  surgery.  Antiseptic  surgery,  originated  by  Lord  Lister, 
has  resulted  in  the  saving  of  untold  thousands  of  lives  and  has  led 
in  turn  to  aseptic  surger}^,  which  is  still  more  effective.  Not  only  has 
it  reduced  the  previous  mortality  from  operations,  but  it  has  vastly 
increased  the  number  and  kind  of  operations  which  can  be  performed 
in  cases  which  under  the  old  regime  would  necessarily  have  proved 
fat  ah 

Of  one  of  the  most  recent  advances  the  eminent  surgeon  Dr.  W.  J. 
Mayo  writes: 

Second  only  to  the  germ  theory  has  been  the  usefulness  of  the  great  discovery 
of  Rontgen  and  the  a[)r)Iication  of  the  X-ray  to  surgical  diagnosis.  It  makes 
certain  the  diagnosis  in  a  large  number  of  conditions  which  were  previously 
a  matter  of  speculation,  and  enables  remedial  surgical  measures  at  an  early 
date,  lessening  mortality  and  morbidity. 

Another  great  surgical  discovery  is  the  suture  of  blood  vessels  evidenced  by 
the  \v(irk  of  Carrel.  Its  i)Ossibilities  are  astounding.  The  ability  to  transplant 
the  kidney  of  one  dog  to  another  and  have  it  continue  its  function,  the  amputa- 
tion of  a  leg  and  its  resuture,  opens  up  the  whole  question  of  the  transplantation 
of  sound  for  diseased  organs,  especially  organs  which  are  double." 

In  these  and  other  surgical  work  a  certain  amount  of  vivisection  is 
necessary.  The  present  outcry  against  vivisection  is  an  example  of  a 
defective  sense  of  proportion.  While  needless  cruelty  should  be 
avoided,  the  suffering  of  animals  through  vivisection,  including  all 
cases  where  the  practice  has  been  abused,  is  as  nothing  compared  with 
the  suffering  of  human  beings  which  would  be  caused  if  all  vivisection 
were  abolished. 

"  Letter  from  Dr.  William  J.  Mayo. 


688  EEPORT   OF    NATIONAL  CONSERVATION   COMMISSION. 

The  progress  of  antisepsis  has  so  reformed  midwifery  that  puer- 
peral fever,  a  former  scourge  of  humanity,  is  now  extremely  rare. 
In  many  cases  the  child,  by  being  freed  from  gonorrheal  contamina- 
tion by  the  mother  at  birth,  has  been  saved  from  blindness." 

The  advance  of  surgery  is  shown  by  the  following  table  of  mor- 
tality of  the  wounded  in  the  wars  of  the  nineteenth  century.  Anti- 
septic surgery  was  introduced  at  the  time  of  the  Franco-Prussian 
war  in  1870-1 : 

Per  cent 

Crimean  war,  English  troops 15.2 

French  troops  in  Italy,  1859-GO 37.4 

German  army,   1870-71 11.1 

Spanish-American,  1S9S 6.  6 

Transvaal,  1900-1901 :       5. 5 

In  general  practice  progress  is  also  being  made.  The  use  of  violent 
drugs  is  fast  going  out  of  fashion.  The  recognition  of  the  self-limit- 
ing character  of  most  of  the  acute  diseases  sounded  the  death  knell 
of  the  harsh  drugging  of  the  olden  time.  Laboratory  experimenta- 
tion and  careful  study  as  to  the  physiologic  and  therapeutic  effects 
of  drugs  have  shown  the  necessity  of  subjecting  everything  material 
or  immaterial,  intended  for  the  relief  of  human  ailments,  to  the 
crucible  of  the  most  rigid  scientific  scrutiny.  This  sentiment  has 
grown  until  in  the  best  medical  circles  it  is  properly  considered  a 
reproach  for  a  physician  to  use  any  preparation  without  an  exact 
knowledge  of  its  composition  and  a  definite  conception  of  the  results 
expected  from  its  administration.  The  number  of  medicines  used  by 
physicians  is  decreasing  and  will,  if  the  predictions  of  experts  in  this 
field  may  be  trusted,  ultimately  be  reduced  to  a  small  fraction  of  the 
present  pharmacopoeia.  Many  medicines,  like  quinine  and  mercury, 
will  of  course  merit  a  continuance  of  use.  Syphilis,  malaria,  hook- 
worm disease,  and  some  other  diseases  are  best  combated  by  drugs. 

Serum  therapy,  although  in  its  infancy  as  to  most  diseases,  has 
opened  up  a  field  of  great  promise.  For  example,  antidiphtheritic 
serum,  the  one  best  understood  and  in  most  common  use,  has  reduced 
the  mortality  in  that  disease  from  50  or  60  to  12  or  11  per  cent.''  Not 
so  much  medicines  or  serums,  but  hygiene,  will  probably  be  the  de- 
pendence of  the  next  generation  of  physicians.  Possibly  the  term 
"  medicine  "  will  some  day  be  almost  as  inappropriate  in  describing 
the  treatment  toward  which  physicians  are  tending  as  the  term 
"  leech  "  now  is  in  describing  the  phj'sician.  The  profession  has 
ceased  to  be  hostile  to  hygienic  treatment,  and  is  slowdy  but  surely 
substituting  it  for  much  of  the  internal  treatment  formerly  employed. 
The  new  treatment  includes  the  use  of  air,  light,  water,  food,  rest, 
massage,  mechanical  vibration,  electricity,  exercise,  and  suggestion, 
under  the  names  of  aerotherapy,  hydrotherapy,  psychotherapy,  etc. 
These  remedies  have  the  great  advantage  of  preventing  as  well  as 
curing  disease. 

It  onl}^  remains  for  all  medical  schools  and  the  courses  of  lectures 
now  gratuitously  provided  by  the  American  Medical  Association  for 
all  county  medical  societies  to  teach  these  things  in  such  a  thorough 
and  practical  way  as  will  reach  the  whole  profession  and  bring  these 

"Elie  Metchnikoff,  "The  Nature  of  Man."  New  Yorli  (Putnam),  1903,  p.  210. 
>  Metchnikoff,  "  The  Nature  of  Man,"  p.  212. 


nsHBB.l  NATIONAL.  VITALITY.  689 

benefactions  to  the  whole  people.  In  proportion  as  prevention  is 
more  important  than  cure,  the  rapid  advance  in  the  knowledge  and 
practice  of  preventive  medicine  will  be  of  value. 

"  To  hygiene  belongs  without  a  doubt  the  place  of  honor  in  modem 
medicine.  It  is  in  the  prevention  of  infectious  diseases  that  the  inter- 
est of  the  medical  art  is  now  mainly  centered."  "  The  best  men  are 
turning  to  these  phj^siologic  methods  with  enthusiasm.*  They  are 
I  learning  to  take  into  account  the  anxiety  and  other  mental  reactions 
of  the  patient  as  to  what  is  said  in  his  presence."  They  are  becoming 
more  public-spirited  and  cooperative,''  and  alive  to  their  responsibil- 
ity to  set  patients  a  good  example  in  living  hygienic  lives.* 

The  trend  toward  prevention  is  indicated  in  various  ways — by  the 
fact,  for  instance,  that  some  physicians  are  now  employed  by  families, 
schools,  firms,  associations,  etc.,  for  the  purpose  chiefly  of  preventing 
rather  than  curing  disease.  Women  dentists  graduating  from  the 
University  of  Michigan  have  made  a  practice  of  attending  to  chil- 
dren's teeth  at  a  stated  amount  per  month.  Employers  are  increas- 
ingly securing  the  services  of  competent  physicians  to  care  for  the 
health  and  physical  welfare  of  their  employees.  This  is  a  preventive 
measure,  and  has  been  found  to  be  a  "  paying  proposition  "  to  the 
ernployer  because  of  the  resulting  enlarged  efficiency  of  the  workers. 

Their  modern  fight  against  tuberculosis  has  led  physicians  to  a 
larger  use  of  fresh  air  in  their  practice.  At  first  many  employed  this 
agent  merely  as  a  "  specific  for  tuberculosis,"  but  its  utility  in  all 
chronic  ailments,  such  as  neurasthenia,  for  instance,  was  next  recog- 
nized. Latterly,  fresh  air  has  been  discovered  to  be  of  use  in  pneu- 
monia and  other  acute  diseases.  It  is  now  not  unusual  to  find  physi- 
cians advising  their  patients,  whether  ill  or  w^ell,  to  sleep  out  of  doors. 
There  can  be  no  question  that  man  was  originally  an  outdoor  animal. 

The  discovery  of  the  germ  origin  of  Asiatic  cholera,  tuberculosis, 
diphtheria,  typhoid  fever,  bubonic  plague,  influenza,  and  other  dis- 
eases, and  of  the  part  played  by  water,  impure  food,  insects,  rodents, 
and  other  common  and  almost  omnipresent,  but  hitherto  unrecognized, 
agencies  as  carriers  of  disease  to  man  and  animals,  has  awakened  a 
world-wide  interest  in  these  subjects  which,  properly  fostered  and 
directed,  opens  up  ever  extending  possibilities  to  the  humanitarian, 
the  economist,  the  statesman,  and,  still  more,  to  the  people  at  large. 

The  consequence  must  be  a  great  revolution  in  medicine  in  the  im- 
mediate future.  The  practice  of  medicine  is  destined  to  become  a 
much  more  powerful  agent  than  ever  before  in  the  suppression  and 
prevention  of  disease.  This  result  will  be  reached  when  the  change 
now  going  on  permeates  the  rank  and  file  of  the  profession.  It  would 
be  a  pity  if,  through  undue  conservatism  of  some  of  its  members,  the 
profession  should  lose  some  of  its  prestige  hard  won  during  the  last 
generation.  Already  the  ever-present  quack  is  pressing  into  the  invit- 
ing field.     As  the  public  demands  "  drugless  treatment "  and  many 


»  Metchnikoff,  "The  New  Hygiene,"  Chica.w  (Keener),  190G,  pp.  12-13. 

6  See  G.  Stanley  Hall,  "Adolescence,"  New  York  (Appleton),  1905,  vol.  1, 
p.  238. 

"See  A.  T.  Schofleld,  "Power  of  Mind,"  London  (Churchill),  1902,  2d  ed., 
p.  277. 

*  See  Osier,  "  Maryland  Medical  Journal,"  October,  1905,  p.  420. 

•See  Professor  Osier's  address  to  St.  Mary's  Hospital,  Loudon,  1907. 


690  EEPOET   OF    NATIONAL,  CONSERVATION    COMMISSION. 

physicians  fail  to  see  and  meet  that  demand  so  far  as  it  is  rational, 
the  quacks  see  their  opj^ortunity.  As  a  consequence,  there  is  fast 
developing  a  species  or  quack  that  not  only  does  not  use  "  patent 
medicines,"  but  condemns  their  use  by  regular  physicians.  Men  of 
this  type  base  their  appeals  on  "  naturopath}^,"  become  "  food  ex- 
perts," prescribe  fasting,  or  two  meals  a  day  or  five  meals  a  day,  give 
lessons  in  "  deep  breathing,"  conduct  outdoor  sanatoria,  and  employ 
light  and  air  baths,  dry  cupping,  mechanical  vibration,  intestinal 
lavage,  water  cures,  electricity,  osteopathic  manipulations,  "  divine 
healing,"  etc.  All  these  methods  have  value  under  certain  conditions; 
the  only  objection  is  that  when  applied  by  the  uneducated  they  are 
utilized  to  poor  advantage.  The  fault  lies  not  in  the  therapeutic 
means  but  in  those  who  use  them.  Physicians  sometimes  confuse  the 
two,  and  make  the  mistake  of  opposing  the  means  and  user  alike. 
They  reject  good  means  of  cure  because  employed  by  "  irregulars." 

The  result  is  that  the  patient  sometimes  finds  the  best  means  of 
recuperation  in  the  hands  not  of  medical  men,  but  of  uneducated 
"physical  trainers."  The  public  will  go  and  should  go  to  those 
who  will  render  the  most  effective  help.  In  order  that  the  medical 
profession  may  suppress  quackery  the  way  must  be  not  to  oppose 
the  use  of  beneficial  therapeutic  agents  in  incompetent  hands,  but 
to  get  their  use  into  competent  hands  by  adopting  them  them- 
selves. There  is  a  quackery  that  is  villainous  and  injurious.  This 
should  be  suppressed.  But  there  is  another  quackery  which  is 
well  intentioned  and  which,  in  spite  of  ignorance,  manages  to  do 
some  good.  The  good  in  it  should  be  appropriated  by  the  profession. 
By  always  promptly  absorbing  the  best  the  profession  will  be  in  a 
position  to  cast  out  the  worst  in  "  irregular  "  systems  of  therapeutics. 
It  may  then  recover  the  ground  which  it  has  too  often  lost.  There 
was  no  reason  why  it  should  have  lost  hundreds  of  thousands  of 
patients  to  "  Christian  Science,"  except  that  these  patients  were  for 
the  most  part  benefited,  and  greatly  benefited,  by  Christian  Science 
after  having  received  no  benefit,  and  often  injury,  from  the  jorofes- 
sion.  "  Easily  physicians,  without  knowing  it,  can  produce  sickness  i 
by  pessimistic  prophecies,  by  anxious  looks  or  words.  Thus  are 
diseases  suggested  (unconsciously)  by  the  physician." °  Had  the 
profession  made  use  of  mental  therapeutics  not  only  could  they  have 
saved  themselves  the  enmity  of  these  hundreds  of  thousands,  but 
they  could  have  nipped  in  the  bud  the  crude  metaphysics  which 
teaches  the  nonexistence  of  disease  and  death  and  the  uselessness  of 
any  therapeutic  agent  except  those  employed  by  the  promulgator. 
The  example  of  so-called  "Christian  Science"  is  only  one  of  several 
protests,  more  or  less  misguided,  against  the  present  practice  of 
medicine. 

Had  all  or  most  members  of  the  profession  conceded  long  ago  the 
harmfulness  of  many,  if  not  most,  violent  drugs  it  might  linv(>  fore- 
stalled the  present  antidrug  movement  among  the  laity.  Tlie  mis- 
guided antivaccination  movement  is  simply  the  carrying  to  extremes 
of  the  antidrug  movement. 

The  Greeks  were  probably  the  most  hygienic  people  that  ever  lived 
and  they  knew  nothing  of  modern  scientific  medicine,  not  even  of 
the  circulation  of  the  blood.    This  shows  that  man's  primitive  knowl- 

•  Scliofield,  loc.  cit.,  pp.  215-216. 


nsHEtt.]  NATIONAL.  VITALITY.  691 

edge  or  instincts  may  be  sufficient  to  enable  him  to  keep  and  develop 

health. 

The  old  code  of  medical  ethics,  though  -well-intentioned,  was  so 
inelastic  and  was  so  susceptible  of  misconstruction  as  often  to  block 
the  way  to  })rogress.  The  magnitude  and  far-reaching  effects  of  this 
evil  were  long  ago  recognized  by  leading  minds  in  the  profession,  and 
after  years  of  agitation  such  a  revision  was  unanimously  agreed  upon 
in  1003  as  makes  the  modern  principles  of  medical  ethics  purely 
advisory  and  far  more  liberal  than  formerly.  All  restrictions  as  to 
consultations  were  removed,  medical  societies  were  thrown  open  to 
reputable  physicians  of  every  school  of  i^ractice  requiring  scientific 
training,  and  agencies  put  in  operation  for  such  organization  and 
cooperation  and  to  encourage  such  liberty  of  individual  opinion  as 
is  demanded  by  the  spirit  of  the  age.  Under  the  most  active  efforts 
of  the  medical  schools,  societies,  and  journals  it  will  doubtless  require 
years  of  time  for  this  liberal  spirit  to  reach  all  members  of  the  pro- 
fession to  the  extent  which  is  so  desirable.  But  when  this  is  done  and 
when  the  public  can  be  made  to  understand  that  it  has  been  done  the 
projudice  whicli  has  hampered  the  profession's  usefulness,  which  has 
made  it  so  difficult  to  secure  and  enforce  health  and  medical  legisla- 
tion necessary  for  the  protection  of  the  highest  interests  of  the  people, 
and  wliich  has  so  fostered  and  given  opportunity  for  quackery,  will 
gradually  become  ancient  history. 

A  frequent  lay  comment  on  some  members  of  the  medical  pro- 
fession is  that  to  be  true  teachers  of  health  they  must  practice  what 
they  preach.  A  physician  can  not  succeed  in  controlling  drug  habits 
or  alcoholism  if  he  has  these  habits  himself.  He  can  not  fight  ^'  patent 
medicines  "  if  he  uses  them  himself.'^  He  can  not  effectively  fight  the 
social  evil  if  he  himself  practices  abortion.  The  standards  of  the 
profession  are  high.  It  is  the  individual  who  is  at  fault.  A  clergy- 
man who  preaches  purity  from  the  pulpit  while  living  a  double  life 
is  disgraced.  In  the  same  way,  now  that  physicians  are  assuming 
the  function  of  giving  instruction  in  orthobiosis  and  hygiene,  they 
are  being  called  to  account  for  their  own  daily  lives.  Self-interest 
and  altruism  alike  will  lead  to  needed  corrections.  The  physician  in 
these  days  of  preventive  medicine  should  keep  himself  well.  The 
challenge  "Physician,  heal  thyself"  is  being  followed  by  the  challenge 
"  Keep  th3'self  well."  Kxniiii!]^  iv.nre  than  precept  is  a  principle  to 
be  applied  here  as  elsewhere.  He  can  not  induce  his  patients  to  diet 
or  take  exercise  if  he  himself  is  addicted  to  the  fleshpots  and  the  easy 
chair.  Many  a  physician  to-day  loses  patients  because  he  and  his 
family  are  on  the  sick  list,  or  because  as  a  man  he  practices  habits 
which  as  a  physician  he  does  not  approve. 

The  physicians  in  this  country  now  number  about  130,000.  Their 
calling  is  in  some  respects  the  noblest  in  the  world  to-day.  During 
the  present  generation  the  profession  has  begun  to  be  appreciated  for 
its  great  services  to  public  and  private  health  and  for  its  self-sacrifice, 
which  is  unequaled  in  any  other  profession  except  the  ministry.  It 
has  now  before  it  an  opportunity  such  as  never  before  existed.  Those 
of  us  who  believe  in  its  mission  look  forward  to  incalculable  blessings 
to  suffering  humanity  from  greater  knowledge  better  applied. 

<»  See  A.  Jacobi,  Journal  American  Medical  Association,  September  29,  1906, 
p.  978, 


692  REPOET   OF    NATIONAIi  CONSERVATION    COMMISSION. 

Section  3. — Institutional   hygiene. 

The  large  cities  have  established  special  contagious  hospitals,  where 
prompt  isolation  of  infectious  cases  may  be  enforced.  The  decrease 
of  tuberculqsis  may  be  traced  largely  to  hospital  isolation.*^  Leprosy 
was  the  first  disease  to  be  quarantined  ^  and  its  virtual  disappearance 
in  civilized  countries  has  been  due,  at  least  in  the  opinion  of  many 
autliorities,  to  the  strict  isolation  methods  universally  adopted. 

Of  a  different  kind  is  the  segregation  of  defective  classes  of  the 
community.  This  has  led  to  considerable  conservation  of  their  powers 
and  abilities.  Institutions  for  the  deaf  and  blind  in  the  United  States 
contained  14,700  inmates  in  1904,  and  spent  for  purposes  of  main- 
tenance over  $3,500,000."  In  these  schools  the  deaf  and  dumb  and  the 
blind  are  taught  trades  and  professions,  their  usefulness  being  thus 
much  enlarged. 

The  New  York  state  commission  on  the  blind  recommended  in  1907; 
a  state  board  for  the  blind  to  conduct  an  employment  bureau  for  the 
blind  of  that  State,  to  establish  schools,  and  to  put  into  operation 
measures  for  the  prevention  of  blindness.  It  is  pointed  out  that  of  the 
100,000  cases  of  blindness  in  the  United  States  a  great  percentage  is 
traceable  to  disease  and  accident  of  a  preventable  character.  The 
commission  estimates  that  of  1,000  cases  in  New  York,  450  were 
possibly  avoidable  and  325  (or  one-third)  certainly  so. 

For,  the  checking  of  insanity  the  crying  need  is  a  study  of  the 
causes  of  the  malady  with  a  view  to  its  prevention.  For,  as  Doctor 
Ditman  remarks,  nine-tenths  of  the  inmates  of  our  insane  as^dums  are 
incurable,  according  to  our  present  knowledge.  He  adds :  "  "Wliat  an 
argument  for  the  prevention  of  the  disease !  "  "*  Much  may  be  ex- 
pected from  the  Plvpps  fund,  for  the  study  of  insanity,  recently 
established  at  Johns  Hopkins  University. 

In  the  first  place,  our  medical  students  should  receive  constant 
clinical  instruction  in  mental  diseases,  particularly  in  their  incipient 
stages.  Almost  equally  important  are  popular  lectures  on  the  pre- 
ventable and  other  causes  of  insanity  given  under  the  auspices  of 
medical  schools  or  local  boards  of  health.  Such  lectures  have  been 
given  in  New  York  and  Boston,  and,  judging  by  the  attendance,  must 
prove  a  valuable  agency  in  diffusing  a  correct  knowledge  of  the  cause 
and  development  of  mental  disease.  In  this  education  of  the  laity 
popular  treatises  on  mental  hygiene  would  prove  most  helpful. 
Such  a  book  as  Doctor  Clouston's  "  Hygiene  of  Mind  "  could,  with 
advantage,  be  placed  in  the  hands  of  every  young  person,  and  might 
even  be  adopted  as  a  text-book  in  high  schools.  Certainly  the  physi- 
ology of  mind  is  as  deserving  of  popular  consideration  as  that  of 
digestion,  respiration,  and  the  circulation. 

By  a  clearer  insight  into  the  beginnings  of  mental  disease,  gained 
through  the  popular  lecture  and  a  nontechnical  literature,  society 
will  become  so  far  enlightened  that  intelligent  personal  prophylaxis 


<»  See  Newsholme,  "  Phthisic  death  rate,"  Journal  of  Hygiene,  July,  IDOG. 

*  See  J.  M.  Eager,  M.  D.,  "The  early  history  of  quarantine,"  Yellow  Fever 
Institute  Bulletin  No.  12,  pp.  4-5. 

«  Census  report  on  "  Benevolent  institutions."  1904. 

*  Ditman,  loc.  cit.  p.  46. 


rtsHKE.]  NATIONAL  VITALITY.  693 

may  be  anticipated."  A  knowledge  of  danger  is  the  surest  means  of 
guarding  against  it.  "  Ttie  most  obvious  line  of  attack  must  be  in 
the  direction  of  the  four  great  etiological  factors  of  insanity,  heredity, 
alcohol,  syphilis,  and  environment.  Abstractly  considered  these  four 
causes  are  preventable  or  removable."  * 

As  an  intermediate  step  between  home  and  hospital,  the  sanato- 
rium offers  both  cure  and  prevention.  Many  tuberculosis  sanatoria 
will  take  patients  only  in  the  incipient  and  early  stages  of  the  dis- 
ease. Sanatoria  are  used  by  many  as  placas  of  recuperation.  The 
tired  business  man  and  the  nervous  housewife  find  at  the  sanatorium 
the  quiet  they  need,  and  a  week  or  two  of  rest  enables  them  to  escape 
threatened  serious  ills. 

Many  public  institutions,  in  response  to  popular  demand,  are  to- 
day installing  methods  and  equipment  that  are  essentially  prevent- 
ive. More  than  one  department  store  in  the  large  cities  filters  its 
air  in  order  that  patrons  and  clerks  shall  not  feel  oppressed  by  vitia- 
tion of  the  atmosphere.  An  indirect  result  is  the  prevention  oi  tuber- 
cular and  other  diseases.  A  leading  hotel  in  Philadelphia  has  pitched 
tents  on  its  roof,  where  a  large  colony  of  well  people — not  sick — 
sleep  out  of  doors,  and  the  same  hotel  utilizes  its  roof  in  winter  for 
a  skating  rink.  Mothers'  clubs  are  an  increasing  factor  in  the  spread 
of  a  knowledge  of  hygiene.  Recently  a  case  came  to  light  of  a  new 
member  of  a  mothers'  club  who  was  feeding  her  5-months-old  baby 
on  sausage,  tea  cake,  etc.,  and  giving  it  drugs  when  she  wanted  to  go 
out.  She  was  greatly  surprised  when  informed  of  the  wrong  she  was 
doing. 

Growing  interest  in  the  science  of  home  economics,  already  re- 
ferred to,  is  an  indication  of  our  increasing  realization  of  the  im- 
portance of  healthful  homes  in  the  community.  While  the  number 
of  schools  and  colleges  which  offer  courses  in  higher  domestic  science, 
and  in  what  might  be  called  "  true  home  economics,"  is  growing,  they 
are  nevertheless  still  comparatively  few.  More  teachers  should  be 
equipped  with  scientific  knowledge  regarding  modern  sanitation  in 
order  that  they  may  give  practical  courses  in  grammar  and  high 
schools,  and  higher  instruction  should  include  the  topics  of  hygiene 
and  sanitation.  Home  making  may  be  studied  in  many  details,  such 
as  the  construction  of  healthful  houses,  the  purification  of  food  and 
water  supplies,  and  the  cleansing  of  cities,  whereby  the  enlistment  of 
both  boys  and  girls  in  all  lines  of  home  and  municipal  hygiene  can 
be  secured. 

The  churches  are  now  joining  in  the  health  movement.  The  lead 
has  been  taken  by  the  Rev.  Elwood  Worcester  and  Rev.  Samuel 
McComb  at  the  Emanuel  Church  in  Boston.  Trained  physicians 
are  employed  for  diagnosis  and  for  general  advice,  but  great  em- 
phasis is  laid  on  the  power  of  suggestion  and  of  Christian  self-con- 
trol over  bodily  ills.  The  object  is  to  get  both  patient  and  physician 
to  stop  "  thinking  sick  and  talking  sick,"  as  Doctor  Golor  has  put  it. 

"A  book  which  brings  the  subject  home  with  unusual  force  to  the  ordinary 
\  reader  is  an  autobiographical  sketch  by  a  recovered  patient,   "A  Mind  that 
Found  Itself."  by  Clifford  W.  Beers,  New  York  (Longmans,  Green),  IDOs. 

*  Charles  P.  Bancroft,  M.  D.,  "  Hopeful  and  discouraging  aspects  of  the  psy- 
■  chiatric  outlook,"  address  at  meeting  of  American  Medico-Psychological  Asso- 
ciation, Cincinnati,  1908. 


694  REPORT   OF   NATIONAL,  CONSERVATION    COMMISSION. 

Section  4. — School  hygiene. 

In  every  progressive  country  to-day  the  hygiene  of  school  life  is 
coming  to  be  regarded  of  paramount  importance.  At  the  Inter- 
national Congress  on  School  Hygiene,  in  London,  August  5-10,  1907," 
there  were  in  attendance  at  least  500  delegates,  rejiresenting  the  gov- 
ernments of  the  world  and  societies  devoted  to  the  advancement  of 
human  welfare,  and  in  addition  there  were  1,500  individuals  inter- 
ested in  the  improvement  of  the  health  of  school  children  and  all 
that  this  implies.  The  fact  was  brought  out  at  the  congress  that 
European  countries,  notably  Switzerland,  Germany,  France,  Eng- 
land, and  Scotland,  are  doing  more  than  the  United  States  in  the 
medical  inspection  of  scliools  and  that  they  are  seemingly  making 
plans  for  the  im]:)rovement  in  every  direction  of  the  hygienic  con- 
ditions of  school  life.''  Even  in  Italy  the  leading  statesmen  are  ap- 
parently convinced  that  the  matter  of  chief  importance  at  the  present 
moment  in  their  educational  work  is  to  place  it,  from  start  to  finish, 
upon  a  hj'gienic  basis." 

It  is  the  unanimous  opinion  of  all  students  of  the  matter  that  the 
neglect  of  the  hygiene  of  school  life  in  the  larger  sense  is,  first  of  all, 
more  or  less  disastrous  to  a  considerable  proportion  of  the  pupils.** 
With  us,  as  well  as  in  most  European  countries,  children  are  com- 
pelled by  the  state  to  attend  school  for  a  number  of  years.  Many 
of  them  suffer  constantly  from  defective  vision,  hearing,  and  respira- 
tion, from  nervous  overstrain,  and  from  other  ailments  which  are 
greatly  aggravated  by  the  confinement  and  stress  of  school  life." 
Pupils  are  always  exposed  to  infectious  diseases.  It  is  no  unusual 
thing  in  our  country  to  see  a  contagious  disease  sweep  through  a 
whole  school  so  rapidly  that  the  local  board  of  health  can  hear  of  it 
and  order  the  school  closed  only  after  the  harm  has  been  done. 

Great  as  is  the  injury  done  bj'  the  spread  of  infectious  diseases  to 
children  thus  massed  together  in  schools,  the  injury  resulting  from 
imperfect  seating,  lighting,  ventilation,  and  sanitation  of  school 
buildings  is  still  more  serious.  In  every  part  of  our  country,  as 
well  as  in  the  progressive  countries  of  EurojDC,  those  familiar  with 


"The  proceeding's  of  the  congress  contain  pnpers  by  distinguished  physicians 
and  educators  upon  every  phase  of  the  hygiene  of  school  life.  Existing  evils 
are  pointed  out  and  reniedios  suggested.  Summaries  of  the  papers  may  be 
found  in  the  Nineteenth  Century,  September,  1907,  pp.  38S-394. 

^  In  addition  to  papers  presented  at  the  International  Congress  on  School 
Hygiene,  see  the  following:  A  series  of  articles  in  the  School  Review  (Univer- 
sity of  Chicago)  for  1907,  by  Prof.  Hermann  Schwartz,  entitled  "The  study  of 
experimental  pedagogy  in  Germany."  Many  articles  in  the  magazine  Zeit- 
schrift  fur  Schulgesundheitsiitloge  sliow  the  great  interest  in  Cermany  in  school 
hygiene.  Professor  P.inet.  of  Paris,  has  esral)lished  a  laboratory  for  the  study 
of  childhood  in  relation  to  educational  work,  and  he  will  give  particular  at- 
tention to  problems  concerning  physical  defects  and  mental  and  moral  short- 
comings. For  other  such  institutions  see  The  Psychological  Bulletin,  Vol.  VI, 
March  15,  1909,  pp.  84-103. 

"  See,  for  example.  Professor  Garlanda's  "II  Terzia  Italia,"  In  which  ne 
shows  the  only  way  in  which  Italy  cini  regain  her  old-time  vigor  and  efliciency. 

'^  See  M.  v.  O'Shea :  "Dynamic  Factors  in  Education."  New  York  (Mac- 
millan),  1900,  Part  II,  where  the  whole  subject  is  discussed. 

"See  Oppenheim :  "The  development  of  the  child,"   Chap.   V.     Also  Tyler:! 
"Growth    and    odumtion;"    Purbank :    "The    training    of   the   human    plant;" 
Burk  :   "From  fmulaniental  to  accessory,"  etc.;  Pedagogical  Seminary,  Vol.  VI. 
Kraeplin:  "A  measure  of  mental  capacity,"  Popular  Science  Monthly,  vol.  49. 


FISHER.]  NATIONAL,  VITALITY.  695 

the  situation  are  appealing  most  urgently  for  improvement  in  the 
physicial  basis  of  edwcation.  This  is  not  the  place  to  recite  the  dis- 
abilities which  are  said  by  men  competent  to  sjoeak  on  the  subject 

■  to  result  from  keeping  children  for  at  least  eight  years  in  confinement 
and  at  hard  mental  labor  under  conditions  that  waste  their  vitality 
and  develop  bodily  defects  and  habits  prejudicial  to  health.  The 
list  of  such  disabilities  is  a  long  and  impressive  one."  Unfortunately, 
we  do  not,  as  a  people,  sufficiently  appreciate  that  the  character  of 
social  life  with  us  is  changing  rapidly,  and  that  consequently  our 
children  are  particularly  susceptible  to  certain  diseases  and  defects; 
to  wit,  those  arising  from  the  adoption  of  an  indoor  life  of  compara- 
tive muscular  inactivity,  with  greatly  increased  demands  made  upon 
particular  organs,  such  as  the  eyes  and  the  brain. 

Doctor  Cronin,  of  New  York,  maintains  that  in  a  school  population 
of  G50,000,  30  per  cent  of  the  children  were  from  one  to  two  years 
beliind  their  proper  class.  Ninety-five  per  cent  of  these  backward 
children  were  so  principallj'  because  of  defects  of  eye,  ear,  nose,  or 
throat,  which  could  easily  be  detected  and  remedied  through  effective 
medical  inspection.  Experiments  at  home  and  abroad  have  proven 
beyond  any  doubt  that  the  majority  of  children  of  this  sort,  when 
given  proper  medical  treatment,  improve  markedly  in  intellect  and 
general  conduct.  The  State  attempts  to  educate  these  children,  but 
its  effects  are  to  a  large  extent  wasted.  Doctor  Osier  calculated 
that  in  the  special  city  to  which  reference  has  been  made  there  was, 
on  account  of  a  lack  of  medical  supervision  of  educational  work,  a 
yearly  financial  loss  of  $1,GGG,666;  and  of  course  the  loss  which  came 
from  moral  deviation  due  to  defective  physical  functioning  was  of 
far  greater  importance.  Doctor  Osier  said  recently,  in  effect,  that 
he  considered  it  of  greater  importance  to  the  nation  that  the  question 
of  sound  teeth  be  intelligently  considered  than  that  the  consumption 
of  alcohol  be  restricted,  important  as  the  latter  problem  is.  In  similar 
vein,  Doctor  Newton  reports  a  case  of  an  old,  unhygienic  school  build- 
ing in  a  small  town  being  fitted  up  with  a  ventilating  system,  with 
the  result  that  the  cost  of  the  improvement  was  saved  in  a  short  time 
in  salaries  that  otherwise  would  have  been  paid  to  extra  teachers  for 
taking  the  place  of  those  made  sick  by  the  foul  air  in  the  building. 
We  now  know  the  major  effects  at  least  on  intellect  and  tempera- 

\  ment  of  sense  defects,  adenoids,  decaying  teeth,  and  minor  physical 

\  deformities;  and  we  also  know  how  such  deviation  from  normality 
can  be  readily  and  inexpensively  detected  and  remedied,''  but  there 
are  whole  States  Avhere  no  advantage  whatsoever  is  taken  of  this 
knowledge,  and  in  practically  ever}'  State  in  the  country  there  are 

[  communities  in  which  absolutely  no  attention  is  paid  to  any  of  these 
matters.  The  people  go  on  in  traditional  ways,  trusting  to  luck  and 
disregarding  the  changes  taking  place  in  society. 

"See  Shaw:  "School  hygiene;"  Keating:  "Mother  and  child;"  Ballantyne, 
I  In  the  Lancet,  Vol.  2,  ISftO ;  Bancroft :  "  Physical  Education  Review,"  Vol.  VII ; 
Rowe,  "  The  lighting  of  schoolrooms ;  "  Burrage  and  Bailey :  "  The  Sanita- 
tion and  decoration  of  school  buildings."  The  Magazine  of  School  Hygiene, 
published  under  the  direction  of  the  School  Hygiene  Association,  contains  in 
each  issue  articles  showing  the  evils  resulting  from  unhygienic  conditions  in  the 
'■:  schools. 

^  See,  for  example,  two  books  by  Doctor  Warner,  of  London :  "  The  Study  of 
Children  "  and  "  The  Nervous  System  of  the  Child."  The  city  of  Chicago  main- 
tains a  department  for  the  study  of  backward  and  defective  children  la  the 
public  schools. 


696 


EEPORT   OF    NATIONAL.  CONSERVATION    COMMISSION. 


The  health  of  our  school  children,  then,  should  be  conserved  by  a 
system  of  competent  medical  inspection"  which  should  secure  the 
correction  of  defects  of  eyes,  ears,  teeth,  as  well  as  defects  due  to 
infection  or  malnutrition.     In  Europe 


all  the  investigations  disclosed  an  astonishing  amount  of  ill  health  among 
school  children;  and  though  the  variations  from  the  normal  were  found  to 
differ  In  degree,  they  were  on  every  hand  alike  in  kind.  In  nearly  every 
Instance  they  were  more  pronounced  in  girls  than  in  boys,  and  were  often  most 
manifest  in  scholars  of  the  better  social  classes.  Thus  there  were  discovered 
the  following  percentages  of  morbidity  among  school  boys:  In  Great  Britain, 
20;  in  Denmark,  29;  in  Germany,  30;  in  Copenhagen,  31  ;  and  in  Sweden,  37. 
The  percentages  noted  among  the  girls  were:  In  Great  Britain,  16;  in  Copen- 
hagen, 39;  in  Denmark,  41;  in  Lausanne,  43;  in  Germany,  50;  and  in 
Stockholm,  62 — an  average  morbidity  for  boys  of  29  and  for  girls  of  42  per 
cent.^ 

Similar  results  have  been  reached  in  certain  cities  of  the  United 
States.  A  "  committee  on  the  physical  welfare  of  scliool  children  " 
in  New  York  City  examined  New  York  school  children  and  found 
that " — 

66  per  cent  needed  medical  or  surgical  attention  or  better  nourish- 
ment. 

40  per  cent  needed  dental  care.<* 

38  i^er  cent  had  enlarged  glands  of  the  neck. 

31  per  cent  had  defective  vision. 

18  per  cent  had  enlarged  tonsils. 

10  per  cent  had  postnasal  growths. 

6  per  cent  were  undernourished. 

Dr.  Walter  Cornell  has  been  making  an  extensive  study  of  eye 
strain  among  school  children.    These  were  his  findings : « 

The  relationship  of  poor  vision  to  scholarship  was  studied  in  219  children. 
As  will  be  noticed,  the  dilTerence  in  marks  between  those  with  normal  and  those 
with  bad  vision  is  greatest  in  arithmetic  and  spelling,  which  studies  require 
more  extensive  use  of  the  blackboard. 

Bcholarship  percentages  obtained. 


Children  with— 


Normal  vision 

Fair  vision 

Bad  vision 


Arith- 
metic. 


79 
70 
66 


Geo,?ra- 
phy. 


69 
71 
70 


Spelling. 


76 
77 
71 


Average. 


75- 
73+ 
69 


In  New  York  City  29.5  per  cent  of  79,0G9  children  examined  suffered  from 
defective  vision.     In  London  26  per  cent  of  20,000  children  examined  by  eight 


«  See  Gulick  and  Ayres.  "  Medical  Inspection  of  Schools,"  Russell  Sage 
Foundation  Publication,  New  York,  190S;  see  also  "The  Psychological  Clinic," 
especially  Vol.  ii.  No.  8. 

"  G.  Woodruff  Johnson,  M.  D.,  "  Effects  of  school  life  on  children's  health," 
North  American  Review,  vol.  1S2,  p.  831. 

"  Ditman,  loc.  cit,  p.  41. 

<*  This  seems  a  low  estimate  in  spite  of  the  fact  that  it  does  not  include  all 
cases  of  decayed  teeth,  but  only  those  tl;at  have  been  neglected.  See  Dr.  William 
R.  Woodbury,  "The  People's  Disease:  How  to  Prevent  it,"  Boston  Medical  and 
Surgical  Journal,  March  26,  1908. 

•  "  Backward  Children  in  the  Public  Schools,"  Philadelphia  (Davis),  1908,  p.  7. 


'isHER.l  NATIONAL   VITALITY.  697 

jphllmlmologists  had  defective  vision,  and  of  tliis  uuuiber  12.5  per  cent  suffered 
roiu  vision  of  one-lialf  or  less.  The  autlior  exiiniinrd  personally  1,156  children 
ind  found  34  per  cont  with  defective  vision,  and  of  this  number  6  per  cent 
svith  vision  one-half  or  less.  A  small  proportion  of  this  number  only  Is  fitted 
jvith  ^classes.  The  rest  suffer  from  I'oal  eye  strain.  The  fault  of  this  deploraiile 
condition  is  divided  among  physicians,  school-teachers,  and  parents.  Ignorance 
)f  the  existing  facts,  indifference,  and  poverty  are  the  real  factors  to  be  dealt 
s^ith. 

Eye  strain  is  the  chief  source  of  the  functional  diseases  of  our  citizens.  It 
)egins  in  early  childhood  and  continues  until  senility  is  conii>lote.  It  is  bound 
;o  occur  in  every  individual  some  time  in  his  life,  to  a  greater  or  less  degree. 
;t  is  almost  the  sole  cause  of  headache,  migraine,  sick  headache,  the  most  fre- 
luent  and  habitually  morbidizing  of  human  diseases.  It  is  the  frequent  cause 
jf  gastric  and  digestional  diseases  and  of  nervous  and  mental  diseases.  With 
)cular  function  it  conditions  the  origin  of  spinal  curvature,  either  directly  or 
ndii'ectly,  through  the  pathogenic  writing  posture.  Lateral  spinal  curvature, 
he  effect  of  visual  function,  becomes  a  new  secondary  source  of  multifarious 
uorbidities,  such  as  neurasthenia,  pelvic  diseases,  hysteria,  etc.  It  has  been 
iemonstrated  that  27  per  cent  of  European  school  children  have  lateral  spinal 
:urvature  at  the  age  of  14,  and  I  have  proved  that  at  least  70  per  cent  of  our 
)wn  16  to  18  year  old  young  men  of  the  educated  classes  have  this  disease. 
Surprise  at  the  fact  will  soon  become  horror  at  the  national  and  social  tragedy 
iphich  these  true  figures  indicate.<^ 

Investigations  in  other  cities  and  States  ^  have  shown  similar  re- 
mits, in  view  of  which  it  is  a  conservative  statement  to  say  that  from 
)ne-half  to  two-thirds  of  our  school  children  need  medical  treatment 
)f  some  sort. 

At  least  one  year  in  each  division  of  schooling,  elementary,  secondary,  and 
tollegiate,  is  lost  to  the  majority  of  students  because  of  unnecessary  sickness 
)r  dullness  caused  by  improper  living." 

That  physical  defects  are  responsible  for  much  of  the  backwardness 
)f  children,  and  for  a  laro-e  share  of  truancy  and  incorrigibility,  is  the 
)pinion  of  many  educators.''  In  order  to  correct  physical  abnoririali- 
ies  and  thereby  to  hasten  mental  and  moral  progress  in  school  life,  a 
lumber  of  cities  have  instituted  medical  inspection  of  schools. 

So  far  as  inquiry  has  been  able  to  discover,  there  were  in  the  month  of 
fune,  1908,  70  cities  in  the  United  States,  outside  of  Massachusetts,  having 
{ome  form  of  medical  inspection  of  schools.  In  the  State  of  Massachusetts  32 
dties  and  321  towns  had  systems  more  or  less  complete.  It  is  at  present  impos- 
;ible  to  compute,  or  even  to  closely  conjecture,  how  many  children  these  systems 
■each  at  the  present  time.  It  is  entirely  certain  that  they  do  not  reach  all  of 
Jie  children  in  the  schools  of  those  cities  and  towns  where  systems  of  medical 
nspection  are  actually  or  nominally  in  operation.'' 

New  Yorli  City  employs  150  physicians,  who  visit  each  public  school  once  a 
lay,  shortly  after  9  o'clock,  to  examine  those  children  set  aside  by  the  teacher 

•Letter  from  Dr.  George  M.  Gould,  who  perhaps  more  than  any  other  Amer- 
.can  has  emphasized  the  evils  of  eye  strain. 

*  See  an  article  by  Prof.  M.  V.  O'Shea  in  the  World's  Work,  Vol.  V,  in  which 
lie  results  of  extensive  investigations  were  given.  See  also  Dr.  W.  B.  Drum- 
nond :  "An  introduction  to  child  study,"  Chs.  IX  and  X,  "  Report  of  Conference 
)f  State  Sanitary  Officers  of  New  York,"  Buffalo,  October,  1907,  and  various 
Baltimore  and  New  York  City  school  reports. 

"  Letter  from  Mrs.  Ellen  H.  Richards. 

*  See  O'Shea :  "  When  character  is  formed,"  Popular  Science  Monthly,  Vol. 
LI;  Rowe:  "Physical  nature  of  the  child,"  Chs.  9,  10,  13,  14;  Scott:  "Sacrifice 
)f  the  eyes  of  school  children,"  Popular  Science  Monthly,  October,  1907;  Gould: 
['The  cause,  nature,  and  consequences  of  eye  strain,"  Popular  Science  Monthly, 
(December,  1905;  Travis:  "The  Young  Malefactor,  a  Study  in  Youthful  Degen- 
i'racy;"  Swift:  "Mind  in  the  making,"  Chs.  IV  and  V;  Tanner:  "The  child," 
3h,  III ;  Kirkpatrick :  "  Fundamentals  of  child  study,"  Ch.  XVII. 

*  Letter  from  Dr.  Luther  H.  Gulick. 


698  EEPORT   OF    NATIONAL  CONSERVATION    COMMISSION. 

as  requiring  attention.  Chicago  employs  nearly  100  physicians  to  visit  her 
public  schools.  In  Chicago  during  the  ten  months  of  the  school  year  ended 
June  26,  190S,  the  medical  inspectors  of  schools  examined  40(;,!)19  i)upils." 

And  one  health  officer,  Doctor  Chapin,  of  Providence,  has  even 
established  a  special  fresh-air  school  for  children  who  suffer  from 
certain  forms  of  tuberculosis  or  who  come  from  tuberculous  families. 
He  says  concerning  it: 

Our  fresh-air  school  has  only  been  running  since  last  January  (1908),  and,  of 
course,  we  have  no  very  definite  results.  All  of  the  children  without  exception 
improved  in  health,  and  gained  in  strength,  and  also  showed  good  mental  prog- 
ress. The  cost  of  the  school  per  capita  is  only  about  HO  per  cent  more  than  in 
the  ordinary  schools,  and  we  believe  that  the  expense  is  fully  justified.  If  wei 
had  a  large  enough  school,  so  that  it  could  be  graded,  the  cost  of  education ; 
would,  owing  to  saving  in  fuel,  probably  be  less  than  in  an  ordinary  school. 

Several  States  are  making  progress  in  these  directions. 

Connecticut,  Massachusetts,  and  Vermont  have  passed  laws  making  examina- 
tion of  eyes,  ears,  and  method  of  breathing  of  the  public  scholars  compulsory, 
while  New  York,  Illinois,  and  some  other  States  of  the  Middle  ^Vest  depend 
upon  the  voluntary  cooperation  of  the  teachers  in  making  this  examination. 
It  would  seem,  however,  that  whether  it  remains  voluntary  or  becomes  com- 
pulsory, its  success  will  be  greatly  enhanced  if  women  who  are  conducting 
teachers'  institutions  in  the  department  of  education  devote  a  half  hour  or  an 
hour  to  the  exposition  of  the  necessity  of  such  an  examination  and  also  in 
explaining  the  method  in  detail  and  the  method  of  tabulating  the  results,  so 
that  the  teachers  may  be  familiar  with  the  tests,  etc.,  when  they  have  to  make 
them.  With  the  great  power  lodged  in  the  department  of  education  in  this 
State,  it  would  seem  justifiable  to  make  this  compulsory.* 

We  in  this  country  should  profit  by  the  experience  of  older  coun- 
tries in  respect  to  school  hygiene.  Switzerland  has  led  the  nations 
in  its  concern  for  the  physical  welfare  of  its  children.  A  number  of 
other  European  countries  are  beginning  to  imitate  Switzerland  in 
attaching  supreme  importance  to  health  and  hj^giene  in  educational 
work.  There  is  now  before  the  English  Parliament  a  bill  the  pur- 
pose of  which  is  to  establish  a  national  system  of  medical  inspection 
of  schools,  and  it  seems  probable  that  this  measure  will  be  enacted 
into  law. 

It  is  generally  recognized  by  physicians  and  educators  to-day  that 
many  children  in  the  schools  are  being  seriously  injured  through  . 
nervous  overstrain.'^     Throughout  the  world  there  is  a  developing  £ 
conviction  that  one  of  the  most  important  duties  of  society  is  to  de-  1; 
termine  how  education  may  be  carried  on  without  depriving  children 
of  their  health.     It  is  probable  that  we  are  not  requiring  too  much 
work   of  our   ptipils,   but  they   are  not  accomplishing  their   tasks 
economically  in  respect  to  the  expendittire  of  nervous  energy.    Some 
experiments  made  at  home  and  abroad  seem  to  indicate  that  children 
could  accomplish  as  much  intellectually,  with  far  less  dissipation  of 
nervous  energy,  if  they  were  in  the  schoolroom  about  one-half  the 
time  which  they  now  spend  there.    German  educators  and  physicians 
are  convinced  that  a  fundamental  reform  in  this  respect  is  needc  1. 
In  fact,  among  school  children  we  are  learning  the  same  lesson  as 

"A.  L.  Craig,  "  Report  of  the  standing  committee  on  contagious,  infectious,  and 
hereditary  diseases,"  Associated  Fraternities  of  America.  August  1,  1908. 

'Twenty-eighth  Annual  Report  State  Board  of  Health  of  New  York,  1908. 

"See  Dr.  Adolph  Meyer,  "What  do  Histories  of  Cases  of  Insanity  Teach  Us 
Concerning  Preventive  Mental  Hygiene  during  the  Years  of  School  Life?  "  The 
Psychologic  Clinic,  June  15,  1908. 


KisnEn.l  NATIONAL  VITALITY.  699 

among  factory  employees,  viz,  that  high  pressure  and  long  hours  are 
not  economy  but  waste  of  time. 

In  American  cities  one  of  the  greatest  needs  to-day,  in  order  to 
conserve  the  vitality  of  children,  is  the  establishment  of  playgrounds 
easily  accessible  to  all  the  children  of  any  community.  We  are  told 
that  the  physical  and  the  mental  are  inseparably  joined  together,  and 
if  the  one  is  defective  the  other  Avill  suffer  through  sympathy.  Now 
it  appears  to  be  impossible  to  develop  the  child  physically  in  any  way 
so  efl'ectively  as  through  active  play.  Formal  gymnastics  can  accom- 
plish relatively  little.  The  child  must  have  some  end  to  attain  that 
arouses  its  enthusiasm,  and  that  demands  agility  and  strength  and 
endurance;  then  its  wiiole  bodily  mechanism  will  work  together  in 
harmony  to  achieve  this  end.  And  this  is  what  a  physical  training 
seeks  to  accomplish — to  make  the  body  a  fit  instrument  for  the  mind. 
Let  the  child  have  some  place  where  it  may  not  only  play  games 
freely  without  fear  of  the  police  but  where  it  may  run  and  jump 
and  climb  and  swing  and  work  in  sand  and  throw  stones  and  wrestle, 
and  it  will  not  fail  to  make  the  most  out  of  the  body  nature  has  given 
it  as  a  housing  for  a  sound  and  efficient  mind. 

Even  if  playgrounds  were  of  no  value  in  social  development,  they 
would  still  be  of  inestimable  service  in  keeping  children  out  of  crime 
and  lessening  expense  for  police,  courts,  reformatories,  hospitals,  and 
prisons — a  point  wdiich  was  strongly  emphasized  in  the  report  of 
1897  of  the  committee  on  small  parks  in  New  York.  If  a  boy's 
energies  are  not  used  up  in  wholesome  activity  they  will  surely  find 
expression  in  illegitimate  conduct.  The  boy  will  prey  upon  the  in- 
stitutions which  prevent  him  from  living  a  natural  life.  ''  The  great- 
est enemy  to  the  police  is  the  boy,"  said  a  high  Philadelphia  official 
recently.  Go  to  the  storekeeper,  to  the  shoplceeper,  to  the  house- 
keeper, and  you  will  hear  the  same  stoiy.  The  boys  steal,  break 
windows,  insult,  afflict,  upset  one  thing  and  another,  and  Avould  do 
.  almost  anything  they  hear  or  see  in  order  to  satisfy  that  burning 
'  instinct  for  play.  "  These  beginnings  of  vice  and  crime  were  the 
onlj^  outlets  they  have  had  for  the  powers  with  which  nature  has 
endowed  them.  These  practices  were  their  only  or  chief  arnusement, 
and  thus  happiness  to  them  became  synonymous  with  vice  and  fiendish 
delight  in  evil  doing."** 

But  in  studying  the  life  on  the  playgrounds  the  same  official  sees 
that  they  lay  the  foundations  for — 

strong,  manly,  bright,  and  liappy  lives,  rescued  from  the  evil  habits  and 
tendencies  that  produce  misery  and  wretchedness.  *  *  *  Through  their  play 
in  this  manner  the  young  are  taught  how  to  live  together,  how  to  respect  each 
,  other's  rights,  how  to  be  kind,  gentle,  pure,  in  language  as  well  as  in  conduct. 
The  boy's  mouth  is  not  defiled  by  tobacco,  liquor,  or  profane  language.  The  dis- 
respectful and  vulgar  treatment  which  young  boys  and  girls  inflict  upon  each 
other  in  the  street  is  done  away  with.  The  playground  influences  are  brought 
into  the  home,  where  the  younger  brothers  and  sisters  treat  each  other  much 
differently  from  the  way  they  do  now ;  or,  to  put  it  the  other  way,  the  influ- 
ences of  the  home,  the  school,  and  of  the  church  are  thus  extended  outside  over 
the  whole  life  of  the  child." 

To  playgrounds  may  be  joined  school  gardens,  which  Superin- 
tendent Maxwell  in  New  York  has  shown  would  not  be  expensive, 

I                      «  Secretary  of  Philadelphia  Culture  Extension  League. 
S.  Doc.  419,  61-2 6 


700  BEPORT   OF   NATIONAL.  CONSERVATION   COMMISSION. 

or  open-air  gymnasia,  or  any  other  equipment  that  will  give  children 
the  opportunity  to  develop  physically. 

Physical  education  is  a  part  of  the  training  in  many  public  schools 
and  in  a  still  greater  number  of  private  schools,  but  there  is  room 
for  improvement.  After  pointing  out,  in  a  recent  article  on  physical 
deterioration,  that  Germany,  France,  and  Austria  have  improved 
their  physical  development  by  compulsory  physical  training  in  all 
civil  and  military  educational  institutions,  the  Rev.  Percy  Stickney 
Grant  advocates  the  instalment  in  the  United  States  of: 

1.  An  effective  system  of  pi^vsical  education  as  a  recognized  part  of  all  public- 
school  systems.  By  "effective"  I  mean  one  that  does  for  a  boy,  as  far  as 
his  physique  is  susceptible,  what  army  setting-up  exercises  do  for  a  recruit. 

2.  Athletic  exercises  in  schools,  using  gymnasia,  baths,  etc. 

3.  Open-air  exercises  and  sports  under  efticient  supervision. 

4.  Summer  camps  free  of  cost,  and  compulsory  attendance  for  boys  of  school 
age." 

The  study  of  hygiene  and  physiology  has  been  part  of  the  public 
school  curriculum  for  some  time,  but  has  been  regarded  by  physiolo- 
gists as  a  somewhat  partisan  and  unscientific  treatment  of  the  physi- 
ological effects  of  alcohol  and  tobacco.  It  should  be  recognized,  how- 
ever, that  it  has  had  a  salutary  effect  and  has  given  school  children  a 
better  idea  of  what  alcohol  means  than  the  most  of  them  had  before.^ 
Local  topics  of  sanitation  may  well  be  taken  up,  as  in  New  Haven 
last  year  when  the  interest  of  all  the  city  school  children  was  enlisted 
in  behalf  of  a  "  clean  city."  Doctor  Stiles,  of  the  Public  Health  and 
Marine-Hospital  Service,  has  proposed  an  annual  "  health  week  "  in 
the  public  schools,  and  this  proposal  has  found  favor  in  several  States. 
In  Georgia  Chancellor  Barrow  has  proposed  an  annual  "  health  day  " 
in  the  public  schools  of  that  State,  which  would  be  devoted  to  lectures 
on  sanitation,  on  the  dangers  to  be  expected  from  unscreened  win- 
dows, and  on  the  character  of  the  hook-worm  disease,  with  suggestions 
as  to  its  elimination. 

At  present  the  schools  look  to  parents  to  instruct  their  children  In  the  sup- 
posedly simple  matters  of  regulating  eating  and  drinking,  exercise,  habits  of 
work,  and  sexual  habits,  while  the  parents  vaguely  hope  (if  they  think  about 
such  matters)  to  be  relieved  of  these  embarrassing  duties  through  the  schools. 
The  truth  is  that  neither  parents  nor  schools  are  to-day  able  to  give  this  much- 
needed  sort  of  education.  The  remedy  must  be  provided  by  the  schools,  which 
in  their  eagerness  to  impart  conventionalized  facts  are  now  quite  blind  to  some 
of  the  most  pressing  needs  of  their  pupils.  Through  the  schools  and  universi- 
ties (or  other  appropriate  organizations)  the  parents  of  the  future  must  be  edu- 
cated both  as  to  the  facts  and  the  moral  aspects  of  bodily  hygiene.  And  it  seems 
not  unreasonable  to  hope  that  some  of  the  lessons  now  learned  only  by  bitter 
experience,  after  much  that  is  best  in  life  has  been  sacrificed  to  ignorance  and 
uncurbed  Impulse,  will  be  assimilated  sufficiently  early  in  life  to  mitigate  mate- 
rially the  lot  of  a  not  inconsiderable  part  of  mankind.  I  believe  the  lengthening 
of  the  span  of  human  life  to  be  among  the  attainable  results  of  such  teaching. 
Is  it  not  likely  that  as  men  grow  wiser  an  increasing  number  will  deliberately 
strive  so  to  regulate  their  lives  as  to  improve  the  expectation  of  crowning  well- 
Bpent  days  with  the  peculiarly  fine  satisfaction  of  old  age?" 

If  the  school  building  were  a  model  of  ventilation,  lighting,  and 
sanitation,  it  would  not  only  conserve  the  health  of  the  school  cliil- 

«  Rev.  P.  S.  Grant,  North  American  Review,  February  1,  1907. 

*  See  Dr.  Helen  Putnam,  "  Studies  of  the  Present  Teaching  of  Hygiene, 
Through  Domestic  Science  and  through  Nature  Study,"  American  Academy 
Medicine  (Easton,  Pa.),  190.5. 

"  C.  A.  Ilertor.  M.  D..  "  The  Common  Bacterial  Infections  of  the  Digestive 
Tract,"  New  York  (Macmillan),  1907,  p.  351. 


FisnBH.l  NATION  All  VITALITY.  701 

Iren,  but  also  serve  as  an  object  lesson  for  hygienic  instruction.  In 
the  same  way  cooking  and  domestic  science  classes  could  be  made  to 
serve  the  double  purpose  of  providing  a  hygienic  noon  meal  and 
:raining  the  school  children,  especially  the  older  girls,  in  the  princi- 
ples and  practice  of  this  vitally  important  subject.  Our  schools  are 
suffering  from  the  conventional  idea  that  education  comes  from 
books.  Education  is  preparation  for  life,  and  should  make  use  of 
jvery  efficient  method  and  element,  manual  training,  athletics,  ob- 
servational nature  study,  laboratory  experiments,  and  object  lessons 
of  all  sorts,  as  well  as  book  instruction. 

Section  5. — Voluntary  and  btisiness  organizations. 

A  host  of  distinctly  voluntary  associations  are  working  for  the 
improvement  of  hygienic  conditions.  Among  them  may  be  men- 
tioned the  National  Association  for  the  Study  and  Prevention  of 
Tuberculosis,  the  Society  for  Sanitary  and  Moral  Prophylaxis,  the 
Chicago  Society  of  Social  Hygiene,  the  Connecticut  Society  of  Men- 
tal Hygiene,  the  national  and  state  child  labor  committees,  the  Con- 
fess on  School  Hygiene,  the  Children's  Aid  societies,  the  Sunshine 
societies,  the  American  Playground  Association,  the  Visiting  Nurses' 
A-Ssociation,  the  Red  Cross  Society,  the  American  Association  for 
Labor  Legislation,  the  numerous  temperance  organizations,  univer- 
sity settlements,  institutional  churches.  Young  IMen's  Christian  Asso- 
dation  and  kindred  associations,  the  American  Physical  Education 
Society,  the  Boston  Health  Education  League,  and  the  American 
Health  League  established  by  the  Committee  of  One  Hundred  on 
National  Health. 

That  various  large  bodies  of  men  are  waking  to  the  importance 
of  health  study  is  shown  by  the  appointment,  at  the  last  annual 
meeting  of  the  Associated  Fraternities  of  .Vmerica,  of  a  committee 
on  infectious,  contagious,  and  hereditary  diseases,  with  Doctor  Craig, 
oi  Chicago,  as  chairman.  Labor  unions  may  well  follow  this  exam- 
ple and  provide  for  the  education  of  their  members  in  the  subject 
af  hygiene.  This  could  be  effectively  combined  with  their  endeavors 
to  shorten  the  hours  of  labor.  Especially  unhygienic  is  tlie  arrange- 
ment by  which  a  man  has  no  interest  in  his  work  beyond  that 
represented  by  his  pay  envelope.  This  fact  has  been  recognized  by 
some  farsighted  employers  of  labor,  with  the  result  that  they  now 
employ  social  secretaries  or  "  welfare  workers "  to  look  after  the 
general  well-being  of  employees.  A  social  secretary  watches  over 
the  health,  comfort,  and  happiness  of  the  force  during  working  hours, 
establishes  lunch  rooms,  rest  rooms,  mutual  aid  associations,  thrift 
funds,  and  penny  provident  banks.  Employers,  as  a  rule,  become 
eager  for  practical  suggestions  and  expert  advice  on  the  well-being 
of  their  employees  as  soon  as  the  matter  is  called  to  their  attention. 
Doctor  Favill,  president  of  the  Chicago  Tuberculosis  Institute,  after 
speaking  before  the  Commercial  Club,  was  urged  by  15  or  20  of  the 
large  employers  present  to  undertake  investigation  of  their  estab- 
lishments and  to  make  recommendations. 

Dr.  Hubert  Higgins  describes  an  interesting  experiment  carried 
out  in  a  mill  near  Paris,  where  there  were  employed  44  men  and  75 
women  and  children.  A  medical  officer  was  employed  to  supervise 
the  sanitary  appliances  and  reg-ulations  and  to  give  careful  instruc- 


702  REPORT   OF    NATIONAL.  CONSERVATION   COMMISSION. 

tion  and  explanations.  He  held  practical  instruction  classes  with 
the  mothers,  lecturing  on  diet  and  cooking,  cleanliness,  the  way  to 
take  body  temperatures,  and  how  to  look  at  the  children's  throats. 

This  experiment  was  entirely  successful,  thougti  the  doctor  lived  in  Paris. 
There  was  not  a  single  death  in  three  years.  There  were  one  or  two  cases  of 
scarlet  fever  and  diphtheria,  that  were  promptly  and  effectively  isolated.  This 
experiment  was  not  philanthropic,  but  financial,  the  employer  realizing  that 
he  had  better  value  in  worli  from  healthy  hands." 

A  few  factories  now  use  or  permit  the  use  of  a  reader  to  read  to 
their  employees,  where  the  manual  nature  of  their  work  is  such  as 
not  to  be  hindered  by  listening  to  a  story.  Others  use  a  piano  and 
have  their  employees  march  in  and  out  to  music.  The  curious 
physiological  relations  between  rhythm  and  work  are  now  being 
observed  by  physiologists.  Laboratory  tests  with  ergometers  seem 
to  show  that  more  work  can  be  done  under  the  stimulus  of  rhythm. 
Soldiers  and  sailors  have  for  ages  made  use  of  music  and  rhythm,  and 
it  would  not  be  beyond  the  range  of  possibility  if  the  factory  system 
should  in  some  cases  find  more  use  for  it  than  at  present.*' 

Unconsciously,  business  corporations  have  also  made  changes  which 
tend  to  improve  the  sanitary  conditions  under  which  their  employees 
work.  In  a  large  telephone  exchange  in  Chicago  the  perfect  worldng 
of  the  apparatus  was  much  hampered  by  dust,  .so  that  insulation  was 
seriously  affected.  To  obviate  this  condition  an  expensive  system 
was  put  into  operation,  by  which  the  air  was  washed  and  pumped 
into  the  rooms  under  ideal  conditions.  What  the  company  aimed  at 
was  the  perfect  health  of  its  apparatus,  but  it  gained  in  addition  a 
decided  improvement  in  the  health  of  its  employees." 

Another  similar  organization,  the  New  England  Telephone  and 
Telegraph  Company,  at  Cambridge,  Mass.,  ventilated  its  officer 
during  the  winter  of  1907-8  witli  unusual  care,  with  the  result  that 
the  number  of  days  of  work  lost  by  its  60  female  emplovees  was  cut  in 
half. 

The  need  of  industrial  efficiency  is  driving  business  men  to  de- 
mand temperance  or  even  total  abstinance  among  their  emploj^ees. 
This  is  one  of  the  most  powerful  motives  to-day  working  against  the 
abu.se  of  alcohol.  In  the  South  employers  and  the  public  see  that 
negroes  who  drink  are  inefficient  and  dangerous.  Railway  officers 
and  the  traveling  public  realize  that  public  safety  requires  sober 
locomotive  engineers  and  firemen.  Even  drinking  among  sailors  is 
being  discountenanced.  Doctor  Grenfell,  the  missionary  among  the 
Labrador  fishermen,  says:  "Why  don't  I  want  to  see  liquor  used  at 
sea?  Because  when  I  go  down  for  a  watch  below,  I  want  to  feel 
that  the  man  at  the  wheel  sees  only  one  light  when  there  is  only  one 
light  to  see." 

Among  semipublic  institutions  witli  power  to  exercise  prodigious 
influence  in  improving  the  public  hcidtli  are  tlie  life  insurance  com- 
panies. Just  as  fire  insurance  companies  make  efforts  to  decrease 
the  risk  of  fire,  so  life  insurance  com{)anies  might  well  join  in  public 
health  movements  to  effect  a  reduction  in  the  human  death  rate. 

Wliile  the  financial  motive  is  sordid,  it  should  be  utilized  because 
of  its  tremendous  power.    The  insurance  companies  to-day  represent 

"Hubert  Higgins,  "  Humaniculture,"  New  Yorlt   (Stokes),  1906,  pp.  209-211. 
*  See  Karl  Riicher,  "Arbeit  and  Rythmus,"  Leipzig,  1902. 
«  See  Outlook,  May  26,  1906. 


»ISHBB.]  NATIONAL  VITALITY.  703 

an  invested  capital  of  over  $3,000,000,000.  An  actuary  recently  re- 
marked to  me,  in  connection  with  this  subject,  that  they  could  without 
feeling  it  contribute  gi-eat  sums  annually  to  the  preservation  of  public 
health.  "When  insurance  companies  were  established,  the  old  dictum 
that  human  vitality  followed  a  fixed  law  served  probably  to  exclude 
the  idea  of  preventing  death  claims  rather  than  paying  for  them. 
Now  that  we  are  learning  the  preventabilit}^  of  disease,  the  time  must 
come  when  insurance  companies  will  take  an  active  part  in  the  fight. 
Even  a  single  company  would  probably  make  a  good  investment  if 
it  sought  to  educate  its  own  "  risks."  But  a  far  more  effective  method 
would  be  a  combination  of  all  companies  to  improve  public  health 
through  the  enactment  of  public  legislation — by  Congress,  state  legis- 
latures, municipal  governments,  and  in  numberless  other  ways." 

Among  some  official  agencies  meant  to  promote  the  social  welfare 
are  two  recent  commissions  appointed  by  the  President — the  Homes 
Commission,  of  1007,  appointed  for  the  purpose  of  studying  the  hous- 
ing conditions  in  the  District  of  Columbia,  and  the  Commission  on 
Country  Life,  appointed  to  study  the  dailj^  life  of  the  farmer.  Farm 
sanitation  will  be  especially  considered. 

Finally,  there  is  a  public  yet  voluntary  agent  in  the  progress  of 
hygiene  that  must  not  be  overlooked,  namely,  the  modern  periodical. 
Not  only  do  the  daily  papers  devote  much  attention  to  questions  of 
health  and  hygienic  reform,  but  the  popular  magazines  have  taken  up 
the  fight  against  disease,  and  are  educating  the  popular  mind,  more 
surely  than  is  realized,  concerning  the  natural  and  normal  way  of  life. 
It  is  necessary  to  add,  how^ever,  that  these  same  periodicals  often 
nullifj'  the  benefits  derivable  from  their  reading  matter  by  printing 
the  most  harmful  of  patent  medicine,  quack,  drug,  and  alcoholic  ad- 
vertisements. Public  odium  should  attach  to  newspapers  and  maga- 
zines that  advertise  hurtful  nostrums.  It  is  impossible  to  estimate 
the  harm  wrought  to  the  public  health  each  year  through  such  ad- 
vertising.'' 

The  daily  papers  are  especially  culpable  in  this  regard,  but  weeklies 
and  monthlies  are  not  wholly  clear  of  the  taint.  When  a  newspaper's 
advertising  space  is  once  bought  by  quacks  or  nostrum  sellers,  its  news 
columns  become  closed  at  once  to  matter  considered  objectionable  by 
such  advertisers.  Frequently  news  items  reflecting  directly  or  indi- 
rectly on  quackery  are  suppressed.  Notable  examples  of  publications 
that  have  taken  strong  ground  against  such  advertising  are  Collier's 
Weekly,  The  Outlook,  The  Ladies'  Home  Journal,  and  a  few — a  very 
few — dail}^  papers. 

"  Since  the  above  was  written  the  Committee  of  One  Hundred  on  National 
Health  has  urged  this  matter  before  the  Association  of  Life  Insurance  Presi- 
dents, which  body  has  appointed  a  committee  to  draw  up  plans.  Also  the  Metro- 
politan Life  Insurance  Company  has  organizeJ  a  bureau  of  cooperation  and 
information  to  aid  in  distributing  information  to  policy  holders  of  the  "  indus- 
trial "  class. 

*  For  further  discussion  of  this  topic  see  a  pamphlet  by  Samuel  H.  Adams  on 
"The  Great  American  Fraud,"  reprinted  by  the  American  JNIedical  Association 
from  a  series  originally  appearing  in  Collier's  Weekly,  and  "A  Century's  Crim- 
inal Alliance  between  Quacks  and  Some  Newspapers,"  by  Champe  S.  Andrews, 
Publications  of  the  Committee  of  One  Hundred,  1907. 


704  BEPOBT   OP   NATIONAL  CONSERVATION   COMMISSIOH. 

Chaptek  IX. — Conservation  through  personal  hygiene* 

Section  1. — Its  importance. 

Following  public  and  semipublic  hygiene,  we  arrive  at  what  is  in 
many  respects  the  most  important  subject  of  all,  personal  hy<^ione.  It 
is  quite  true  that  the  individual  is  often  at  the  mercy  of  unclean 
streets,  bad  drainage,  impure  water  and  food,  and  other  shortcomings 
of  public  and  semipublic  hygiene.  On  the  other  hand,  his  own  per- 
sonal interest  is  necessary  in  order  to  form  the  public  opinion  which 
alone  can  result  in  effective  public  and  semipublic  hygiene,  while  that 
interest  is  still  more  necessary  to  make  such  hygiene  apply  directly  to 
his  own  person.  Clean  streets  are  of  use  onh^  as  they  make  the  air 
breathed  purer,  but  they  are  of  little  avail  to  the  household  which  does 
not  ventilate  its  rooms  or  which  keeps  them  in  a  state  of  filth.  The 
milk  supply  of  a  city  may  be  ideal,  but  all  the  pains  to  make  it  so 
will  be  set  at  naught  if  the  individual  consumer  allows  the  milk  to  be 
contaminated  after  it  is  delivered.  The  labeling  of  foods  and  drugs 
will  not  prevent  self-poisoning  through  alcohol,  nor  will  the  elimina- 
tion of  preservatives  from  foodstuffs  and  the  enforcement  of  sanita- 
tion in  their  manufacture  be  of  avail  if  in  their  preparation  for  the 
table  they  are  subjected  to  disease  and  dirt.  Thus  at  every  point  of 
hygienic  progress,  there  must  be  individual  cooperation  with  public 
efforts. 

When,  contrariwise,  health  organizations  and  officials  are  inefficient, 
the  individual  may,  in  spite  of  these  difficulties,  often  maintain  good 
health.  In  New  York  a  woman  who  was  the  occupant  of  a  tenement 
overcame  tuberculosis  by  sitting  daily  on  her  fire  escape.  The  air 
was  not  the  best,  but  it  was  much  better  than  indoors.  Similar  results 
have  been  obtained  by  workmen  in  Brockton  shoe  factories,  who,  in 
spite  of  insanitary  working  places,  and  without  cessation  of  work, 
conquered  tuberculosis  by  sleeping  on  the  roofs  of  their  houses  at 
night. 

Observation  shows  that  many,  possibly  most,  of  the  world's  most 
vital  men  and  women  have  virtually  made  over  their  constitutions 
from  weakness  to  strength.  Cornaro,  the  famous  nonogenarian,  Kant, 
and  Humboldt  are  cases  typical  in  different  fields  of  achievement. 
Cornaro,  a  Venetian  nobleman  born  about  the  middle  of  the  fifteenth 
century  and  given  up  to  die  at  the  age  of  37,  forswore  all  unhygienic 
habits  and  began  to  live  "  the  temperate  life,"  his  abstemiousneas 
applying  especially  to  food.  His  age  at  death  is  variously  estimated, 
but  he  lived  to  be  at  least  97.  When  over  90  he  wrote  a  treatise  on 
longevity,  laying  down  as  the  chief  rules  of  a  normal  life,  care  in 
eating  and  drinking,  and  the  avoidance  of  melancholy  and  passion.* 

Centenarians  have  usually  been  persistent  followers  of  some  rule  or 
rules  of  rational  h3^giene,  even  though  unconsciously.* 

Metchnikoff  points  out "  that  part  of  the  supposed  inheritance  of 
longevity  may  not  be  inheritance,  but  similarity'  of  environment,  and 
that  it  very  frequently  happens  that  husband  and  wife  both  live  to  be 

"See  L.  Cornaro,  "The  Art  of  Living  Long"  (English  translation,  Wna.  F. 
Butler,  Milwaukee),  1903. 

>  Metchnikoff,  "The  Prolongation  of  Life,"  p.  141. 
0  Ibid.,  p.  86. 


usHEtt.]  NATIONAL,  VITALITY.  705 

over  100.  This  could  scarcely  happen  by  accident,  but  must  be  due  to 
similar  habits  or  environment. 

Humboldt  confessed  to  a  fellow-student  that  in  the  first  years  of 
his  childhood  his  tutors  were  doubtful  whether  even  ordinary  powers 
of  intelligence  would  ever  be  developed  in  him,  and  that  it  was  only 
in  the  advanced  part  of  his  boyhood  that  he  began  to  show  any  evi- 
dence of  mental  vigor.  As  a  boy  he  suffered  from  debility  which  not 
infrequently  produced  great  prostration." 

Of  recent  examples  may  be  mentioned  a  young  physician  who  was 
given  up  to  die  of  tuberculosis  five  years  ago,  but  who  to-day  can 
run  25  miles  without  a  rest;  and  Horace  Fletcher,  who  in  his 4:6th  year 
was  rejected  for  life  insurance,  but  who  later  not  only  obtained  his 
insurance,  but  proved  his  powers  of  endurance  by  cycling  190  miles 
on  his  50th  birthday. 

And  not  only  can  weakness,  if  recognized  early  enough,  be  turned 
into  strength,  but  strength,  however  great,  may  be  dissipated  in  an 
incredibly  short  time. 

Personal  hygiene  means  the  strengthening  of  our  defenses  against 
disease.  Public  hygiene  seeks  to  destroy  the  germs  before  they  reach 
our  bodily  defenses.  These  two  branches  of  hygiene  are  simply  the 
two  forms  of  warfare,  defensive  and  offensive.  Both  are  of  tran- 
scendent importance,  but  the  defensive  warfare  is  more  within  our 
power.  We  always  have  our  defending  garrison,  the  white  blood 
corpuscles,  to  deliver  us  from  our  enemies.'' 

Section  2 — Branches  of  personal  hygiene. 

Personal  hygiene  comprises  hygiene  of  environment  (air,  soil, 
dwelling,  clothing)  ;  hygiene  of  nutrition;  and  hygiene  of  activity. 

Man  is  more  dependent  upon  the  atmosphere  than  upon  any  other 
environmental  factor.  His  body  is  bathed  in  air  and  his  most  vital 
function,  respiration,  depends  upon  it.  Deprived  of  air,  he  will 
shortly  suffocate.  If  the  air  is  confined  and  impure,  his  health  will 
be  affected.  Ideal  air  should  first  of  all  be  pure — i.  e.,  free  from  in- 
jurious bacteria,  from  dust,  smoke,  and  noxious  gases.  It  should 
also  conform  to  certain  standard  conditions  of  humidity  and  tem- 
perature. In  this  field  lie  the  sciences  of  climatology  and  meteor- 
ology. Man  learned  long  ago  how  to  make  himself  almost  inde- 
pendent of  climatic  and  atmospheric  conditions  by  the  use  of  dwell- 
ings and  clothing.  These  contrivances,  however,  while  protecting 
him  from  the  elements,  have  brought  evils  of  their  own.  The  great 
scourge  of  tuberculosis,  for  instance,  is  principally  an  indoor  disease. 

Intimately  related  to  the  appropriation,  through  the  lungs,  of  oxy- 
gen from  the  atmosphere  is  the  ingestion  of  food  and  drink  through 
the  alimentary  canal.  Normal  health  conditions  demand  in  the  case 
of  ingested  materials,  as  in  the  case  of  respired  air,  the  greatest  possi- 
ble purity,  freedom  from  injurious  bacteria,  and  the  absence  of  sub- 
stances hurtful  mechanically  or  chemically. 

Finally,  the  ideal  conditions  of  health  require  perfect  balance  of 
work,  play,  and  sleep. 

•  "  Life  of  Alexander  von  Humboldt,"  by  Lowenberg  Ave-Lallewort  and  Dore, 
translated  by  Jane  and  Caroline  Lassell,  New  York  (Lee  &  Sliepard),  1873, 
Tol.  I,  pp.  30-32. 

*  Metchnikoff,  "  The  New  Hygiene,"  p.  14. 


706     ■        REPORT   OF    NATIONAL,  CONSERVATION   COMMISSION. 

While  absolutely  perfect  conditions  in  these  three  branches  of  hy- 
giene are  unobtainable,  hygienic  progress  consists  in  approaching 
these  ideals  as  closely  as  possible. 

The  rules  of  personal  hygiene  are  expressed  in  standard  medical 
works  on  the  subject.  There  is  nothing  novel  in  the  brief  resume 
which  follows.  The  radical  changes  in  habits  of  living  which  are 
now  being  advocated  and  to  some  extent  practiced  imply  nothing 
new.  They  have,  for  the  most  part,  long  been  commonplaces  of  the 
medical  profession.  The  knowledge  is  old.  It  is  the  application 
which  is  new.  Medical  men  have  long  been  telling  their  patients  to 
get  plenty  of  fresh  air  and  to  masticate  their  food.  But  until  re- 
cently their  advice  has  fallen  on  deaf  ears. 

Section  3 — The  hygiene  of  environment. 

Air  hygiene  deals  first  of  all  with  ventilation."  The  importance  of 
properly  ventilating  houses  is  so  great  that  to  secure  this  end  the  ar- 
chitecture of  houses  will  have  to  be  changed.  The  worst  historical 
instances  of  bad  ventilation  are  the  imprisonment  and  virtual  suffoca- 
tion of  146  persons  in  the  "  Black  Hole  "  of  Calcutta  and  the  confine- 
ment of  300  men  in  an  underground  room  after  the  battle  of  Auster- 
litz.  The  evils  of  overcrowding  come  mainly  from  exhaled  air  and 
from  the  effluvia  thrown  off  by  the  skin.  Not  only  does  overcrowding 
bring  bad  air,  but  it  also  increases  the  opportunity  for  infection. 

The  air  in  our  houses  has  impurities  of  its  own.  Oil  and  gas  vitiate 
it.  Electric  lights  are  hygienic  in  this  respect.  Air  is  never  quite 
free  from  dust  impurities.  Aitkin  estimates  that  country  air  carries 
2,000  dust  particles  per  cubic  centimeter,  city  air  3,000,000,  and  in- 
habited rooms  30,000,000. 

In  a  clean  hospital  ward,  when  air  was  agitated  by  dry  sweeping, 
the  number  of  colonies  of  bacteria  collected  on  a  given  exposure  rose 
from  26  to  532,  showing  the  effect  of  ordinary  broom  sweeping.  The 
broom  is  now  being  replaced  by  the  carpet  sweeper,  and  the  carpet 
sweeper  in  turn  by  the  vacuum  cleaner.  Each  step  represents  progress 
in  the  elimination  of  dust.  The  removable  rug  is  in  this  regard  an 
improvement  over  the  carpet. 

Air  may  even  be  poisoned  by  the  chemicals  contained  in  wall  paper 
or  in  the  plaster  of  a  brick  and  mortar  dwelling. 

The  one  place  where  the  individual  has  more  control  over  the  air 
he  breathes  than  anywhere  else  is  his  sleeping  room.  He  may  be 
powerless  to  control  the  air  in  his  place  of  work,  or  even  in  the  rooms 
where  he  lives  during  the  day.  But,  except  where  he  shares  a  bed- 
room with  others  who  are  averse  to  modern  ideas  of  ventilation,  he 
can  largely  control  the  air  supply  during  sleep,  and  this  means  during 
one-third  of  his  whole  time.  He  can  open  wide  his  windows  and  in 
many  cases  arrange  actually  to  sleep  out  of  doors.  The  growing  prac- 
tice of  sleeping  out  of  doors  is  one  of  the  most  significant  signs  of  the 
times.  Only  those  who  have  tried  it  realize  the  benefits.  The  air 
supply  in  public  places  would  be  under  the  control  of  individuals,  if 
organized  in  protest;  and  our  churches,  theaters,  public  halls,  railway 
coaches,  and  railway  sleepers  would  be  properly  ventilated  if  the 

"See  Richards  and  Woodman,  "Air.  Water,  and  Food,"  New  York  (Wiley), 
1904;  also  Carpenter,  "Heating  and  Ventilating  Buildings,"  New  York  (Wiley), 
1905;   Sykes,  "  Public  Health  and  Housing"  Loudon  (King),  1901,  216  pp. 


FISHER.]  NATIONAL.  VITALITY.  707 

public  demanded  improvement.  Such  a  "  score  card  "  as  Prof.  John 
R.  Commons  has  devised  for  measuring  the  relation  of  housing  con- 
ditions to  an  ideal  standard  might  well  be  used  in  measuring  the 
health  utility  of  public  places. 

The  windows  of  living  and  work  rooms  may  be  opened  in  summer 
and  somewhat  in  winter,  provided  a  window  board  is  used,  to  deflect 
the  cold  air  upward  from  the  sill.  It  then  does  not  form  a  cold 
stratum  on  the  floor,  but  mixes  evenl}^  with  the  air  of  the  room.  This 
simple  device  would  go  far  to  solve  the  question  of  winter  shut-ins 
and  their  ailments.  In  many  cities  sleeping  balconies  are  not  uncom- 
mon among  the  dwelling  houses. 

The  many  benefits  from  a  pure  air  supply  are  only  beginning  to  be 
realized.  For  instance,  as  long  as  "  the  outdoor  life  "  is  lived  a  cold 
is  almost  impossible.  Army  officers  have  noted  that  as  long  as  the 
men  are  on  the  march  and  sleep  outdoors  they  hardly  ever  have  colds, 
but  that  they  become  troubled  with  these  as  soon  as  they  get  indoors. 
Franklin,  a  century  ago,  knew  these  facts,  though  few  of  the  present 
generation  are  acquainted  with  them.  He  believed  "  that  people  who 
live  in  the  forest,  in  open  barns,  or  with  open  windows,  do  not  catch 
cold,  and  that  the  disease  called  '  a  cold  '  is  generally  caused  by  impure 
air,  lack  of  exercise,  or  from  overeating."  He  came  to  the  conclusion 
that  influenzas  and  colds  are  contagious — a  doctrine  which,  a  century 
and  a  half  later,  wa-s  proved,  through  the  advance  of  bacteriological 
science,  to  be  sound.  The  following  sentence  exhibits  remarkable  in- 
sight, considering  the  state  of  medical  art  at  that  time :  "  I  have  long 
been  satisfied  from  observation  that  besides  the  general  colds  now 
termed  '  influenzas  '  (w^hicli  may  possibly  spread  by  contagion,  as  well 
as  by  a  particular  quality  of  the  air),  people  often  catch  cold  from 
one  another  when  shut  up  together  in  close  rooms  and  coaches,  and 
when  sitting  near  and  conversing  so  as  to  breathe  in  each  other's 
transpiration;  the  disorder  being  in  a  certain  state."  In  the  light  of 
i present  knowledge  what  a  cautious  and  exact  statement  is  that." 

Jolm  Muir,  the  geologist  and  naturalist,  says  that  he  finds  home 
the  most  dangerous  place  he  can  visit. 

As  long  as  I  camp  out  in  the  mountains  witliout  tents  or  blankets  I  get  along 
very  well,  but  the  minute  I  get  into  a  house  and  have  a  warm  bed  and  begin  to 
live  on  fine  food,  I  get  into  a  draft,  and  the  first  thing  I  know  I  am  coughing 

iand  sneezing  and  threatened  with  pneumonia,  and  am  altogether  miserable. 
Atmospheric  evils  come  from  improper  ventilation,  and  affect  either 
the  respiratory  organs  of  the  body  or  the  skin.  It  has  been  supposed 
until  recently  that  the  presence  of  carbon  dioxid  gas  in  vitiated  air 
was  the  chief  evil  caused  by  such  air.  Impure  air  will  affect  the 
lungs  harmfully,  but  not  till  the  amount  of  carbon  dioxid  con- 
Itained  is  very  large.  Guinea  pigs,  on  which  the  effects  of  bad  air 
were  observed,  were  not  seriously  affected  by  the  carbon  dioxid  till 
it  amounted  to  14  per  cent  of  the  volume  of  the  air.  Fliigge  and 
others  have  found  that  the  evil  of  close  atmospheres  is  largely  a  result 
of  elevated  temperature,  humidity^  and  absence  of  air  currents.  Tests 
were  made  on  men  who  sat  in  mipure  air,  but  breathed  pure  air 
through  tubes,  and  they  presented  all  the  symptoms  usually  resulting 
from  bad  ventilation. 


"  From  "  Benjamin  Franklin  as  Printer  and  Philosopher,"  address  of  Presi- 
dent Charles  W.  Eliot  before  American  Philosophical  Association,  April  30,  190G. 


708  EEPORT   OF    NATIONAL.  CONSERVATION    COMMISSION. 

Air  baths  have  been  shown  to  be  as  important  for  bodily  health  a! 
water  baths.  For  this  purpose  porous  clothing  should  be  worn  anc 
no  more  of  it  than  is  needful.  Impervious  cloth  and  rubber  are  prob 
ably  injurious  as  clothing.  Loosely  woven  worsteds,  or  linen  anc 
cotton  mesh  are  best  adapted  to  let  the  air  play  on  the  skin.  Clothing 
to  be  hygienic,  should  not  constrict  the  body.  Tight  shoes,  anc 
especially  tight  corsets,  are  distinctly  injurious,  and  the  injury  t( 
mothers  from  the  latter  may  be  felt  b}^  the  next  generation.  Anothe] 
insanitary  feature  in  clothes  is  the  trailing  skirt,  which  drags  indoor 
the  sputum  of  consumptives  and  germ-laden  dirt  from  the  sidewalk 

Closely  connected  with  air  and  ventilation  is  light.  The  benefit  o; 
sunshine  in  killing  germs  and  improving  bodily  vigor  in  every  waj 
is  too  well  known  to  need  more  than  mention.  Tuberculosis  and  othe: 
germs  thrive  only  in  dark,  damp,  ill-ventilated  places. 

Light  has  its  most  important  bearing  on  the  human  health  througl 
the  sense  of  sight.  Its  relation  to  eye  strain  has  been  discussed  else 
where.  Headaches,  backaches,  indigestion,  hysteria,  and  epilepsy  ar 
often  aided  by  glasses. 

Section  4. — The  hygiene  of  nutrition. 

A  primary  necessity  for  hygienic  living  is  good  drinking  water 
The  modern  man  of  means  insists  upon  good  water,  and,  as  a  result 
the  traveling  public  is  now  able  to  get  first-class  water  in  cars,  hotels 
and  other  public  places.  The  improvement  was  brought  about  b; 
the  appreciation  by  the  consumer  of  the  danger  of  drinking  impur 
water.  It  is  the  consumer  who  has  it  in  his  power  to  bring  about  tb 
necessary  reforms  in  public  hygiene.  When  he  really  values  hygieni 
environment  producers  will  supply  it.  Professor  Sumner  has  told  u 
that  persons  in  the  middle  ages  sometimes  drank  out  of  their  casti 
moats,  which  contained  sewage.  Even  in  New  York  to-day  the  roo 
tanks  are  sometimes  used  as  baths  or  laundries;  and  they  accumu 
late  dust  and  flies  very  rapidly.  Only  a  few  years  ago  the  nldermei 
in  a  prominent  western  town  laughed  out  of  court  a  physician  whi 
called  their  attention  to  dangers  which  were  real,  but  which  they  be 
lieved  imaginary,  from  a  polluted  water  supply. 

The  scientific  study  of  diet  has  only  just  begun  and  few  authori 
tative  results  can  yet  be  stated.  To  avoid  a  lengthy  review  o 
controversial  literature  it  seems  best  to  pass  the  subject  over  rapidlj 
referring  the  reader  for  further  information  to  some  of  the  principa 
books  on  the  subject. 

We  have  already  seen  the  surprising  improvement  in  enduranc 
which  followed  the  adoption  of  thorough  mastication  in  place  of  th 
ordinary  food  bolting.  Mr.  Gladstone  used  to  be  noted  for  his  car 
in  slowly  masticating  his  food,  and  latterly  Mr.  Horace  Fletcher  ha 
aroused  the  interest  of  the  public  in  the  subject  in  Europe  and  Amer 
ica."  He  has  also  stimulated  a  large  number  of  physiologists  to  stud; 
the  subject  of  mastication,  the  protein  ration,  and  their  relation  t 
strength  and  endurance. 


•  See  Horace  Fletcher,  "  The  A,  B-Z  of  our  Own  Nutrition,"  New  Tor 
(Stokes),  1903;  Dr.  Hubert  Higgins,  "  Humaniculture,"  New  York  (Stokes) 
1906;  and  Irving  Fisher,  "The  Effect  of  Diet  on  Endurance,"  publications  ct 
Yale  University,  Transactions  of  the  Connecticut  Academy  of  Arts  and  Sciencei 
1907. 


riSHiE.]  NATIONAL.  VITALITY.  709 

A  great  deal  has  been  written  as  to  what  foods  are  best.  There 
exist  various  dietetic  cults,  such  as  vegetarians  and  fruitarians,  raw- 
food  advocates,  etc.  The  question  of  what  foods  are  ideally  best  is 
too  large  a  one  to  be  entered  upon  here.  The  evidence  seems  to  point 
to  a  general  conclusion  that  no  hard-and-fast  rule  of  exclusion  is 
advisable,  and  that  the  value  of  different  foods  varies  with  the  indi- 
vidual and  with  his  activity,  locality,  physical  condition,  etc.  His 
own  instinct,  restored  and  educated  by  avoiding  the  pernicious  habit 
of  food  bolting,  may  be  made  a  truer  guide  than  the  wisest  physician 
or  physiologist.  The  same  rule  applies. to  the  amount  of  food  to  be 
eaten,  as  well  as  to  the  proportions  of  protein,  fat,  carbohydrates," 
and  mineral  salts.     Food  bolting  often  leads  to  overeating. 

It  should  be  noted  that  the  conclusions  of  Chittenden  and  others 
are  not  in  favor  of  a  vegetarian  regime,  but  of  a  low  protein  regime, 
whether  vegetarian,  lacto-vecetarian,  or  with  flesh  foods  in  modera- 
tion.  The  main  point  is  moderation  of  the  foods  highest  in  protein, 
such  as  the  whites  of  eggs  and  meats  (especially  lean  meats). 

It  would  seem  that  the  safest  course  for  the  average  man  is  to  fol- 
low the  appetite,  simply  guiding  it  toward  a  low  protein  diet  by  thor- 
ough mastication,  and  by  giving  the  benefit  of  the  doubt  to  foods  low 
in  protein.  A  reduction  in  the  use  of  meat  will  increase,  and  probably 
cheapen,  our  national  food  supply.  The  raising  of  cattle  requires 
much  more  land  than  the  raising  of  cereals,  fruits,  nuts,  and  vege- 
tables yielding  the  same  amount  of  food  value.  As  this  will  be  a  most 
important  economic  problem  during  the  next  hundred  years,  the  ques- 
tion of  the  character  of  our  food  supply  should  be  most  carefully 
considered  in  the  study  of  the  conservation  of  natural  resources.  It 
is  interesting  to  note,  in  this  connection,  that  during  the  last  century 
the  consumption  of  flesh  foods  in  the  United  States  has  considerably 
decreased.^ 

The  subject  of  auto-intoxication  as  a  consequence  of  excessive  pro- 
tein has  already  been  mentioned.*'  To  avoid  auto-intoxication  the 
putrefactive  bacteria  may  be  neutralized  by  lactic  bacilli,  such  as  are 
contained  in  sour  milk.  Another  preventive  is  regular  attention  to 
thorough  evacuation. 

Diseased  foods  are,  needless  to  say,  dangerous.  Oysters  are  often 
planted  in  waters  polluted  with  sewage,  with  the  result  that  epidemics 
of  typhoid  fever  have  been  traced  to  their  consumption. 

The  housewife  must  be  the  guardian  of  the  family  in  these  respects, 
and  in  the  cooking,  preparation,  and  arranging  of  food  generally. 
These  now  constitute  "  domestic  science,"  which  is  justly  winning 
recognition  as  one  of  the  most  potent  of  all  hygienic  agencies.    When 

<»  For  a  short  method  of  measuring  these  magnitudes,  see  Irving  Fisher,  "A 
New  Method  of  Indicating  Food  Values,"  American  Journal  of  Physiology,  Vol. 
XV,  No.  V,  April  2,  1906 ;  and  for  its  practical  application  see  "A  Graphic 
Method  in  Practical  Dietetics,"  Journal  American  Medical  Association,  Vol. 
XLVIII,  April  20,  1907.  See  also,  "  Statistics  of  Diet  in  Consumptive  Sana- 
toria," American  Journal  Medical  Sciences,  September,  1906. 

*  See  G.  K.  Holmes,  "  Meat  Supply  and  Surplus,"  Bureau  of  Statistics,  De-' 
partment  of  Agriculture,  Bulletin  55,  1907,  p.  47.  Mr.  Holmes  finds  that  the 
consumption  of  dressed  meat  per  capita  in  the  United  States  decreased  between 
■  1840  and  1900,  40  per  cent,  and  between  1S90  and  1900,  25  per  cent. 

°  Supra,  Chap.  V.  See  also  Herter's  "  Common  Infection  of  the  Digestive 
J  Tract" 


710  REPORT   OF    NATIONAL  CONSERVATION   COMMISSION. 

the  kitchen  becomes  a  scientifically  conducted  laboratory  we  shal 
have  the  basis  of  a  sound  "  home  economics." 

Section  5. — Drug  habits. 

It  would  scarcely  be  nn  exnjigeration  to  say  that  the  first  rule  oi 
hygiene  is  to  avoid  poisons.  Poisons  may  be  generated  within  us 
or  ingested  from  without. 

Drug  habits  take  numerous  forms,  and  they  are  more  prevalent 
than  most  persons  realize.  The  commonest  form  of  intoxication  k 
alcoholic."  It  is  ijiteresting  to  observe  the  change  which  has  com«i 
about  in  the  attitude  of  scientists  toward  alcohol.  From  having  en- 
joyed a  high  place  in  materia  medica,  it  is  in  danger  of  being  com- 
pletely discredited.*  So  far  as  its  habitual  use  is  concerned  the  onlj 
question  which  remains  in  debate  is  whether  in  minute  quantities  it 
may  be  innocuous  or  even  beneficial.  In  any  except  minute  quantitiei! 
it  has  been  shown  to  be  injurious. 

It  lowers  the  resistance  of  the  white  corpuscles,  which  are  the  natural  de^ 
fenders  of  the  body.  Although  the  phagocytes  belong  to  the  most  resistani 
elements  of  our  body,  yet  it  is  not  safe  to  count  on  their  insensibility  toward 
poisons.  It  is  well  known  that  persons  who  indulge  too  freely  in  alcohol  sho\^ 
far  less  resistance  to  infectious  diseases  than  abstemious  individuals.^ 

Here  is  the  gravest  indictment  that  may  be  brought  against  the 
abuse  of  alcohol.  It  is  not,  however,  the  only  one.  The  relation  o1 
drinking  to  insanity,'*  peripheral  neuritis,  Bright's  disease,  cirrhosis 
of  the  Tiver,  inflammation  of  tlie  stomach,  arteriosclerosis  (a  mosi 
common  cause  of  apoplexy ),«  tuberculosis;  f  to  crime  in  all  its  forms,' 
and  to  all  the  possibilities  incident  to  the  hereditary  transmission  o: 
a  weakened  organism''  has  been  pointed  out.  If  personal  hygiene 
is  a  duty,  it  is  the  duty  of  every  man  to  recognize  the  danger  fron 
alcohol  to  himself  and  to  his  progeny  yet  unborn.  Instead  of  copying 
the  habits  of  otliers,  he  may  consider  the  responsibility  of  causing 
others  to  copy  his. 

A  subcommittee  of  the  Committee  of  Fifty  for  the  investigatior 
of  the  liquor  problem  published  in  1899  a  volume  on  the  economic 


"  For  a  discussion  of  the  physiological  effects  of  alcohol,  see  Physiologica: 
Aspects  of  the  Liquor  Problem,  investigations  made  under  the  direction  oj 
W.  O.  Atwater,  John  S.  Billings,  II.  P.  Bowditch,  R.  H.  Chittenden,  and  W.  H 
Welch,  subcommittee  of  the  Committee  of  Fifty;  New  York,  Houghton  &  Mifflin 
1903,  2  vols.;  and  The  Liquor  Problem,  a  Summary  of  Investigations  Conducts' 
by  the  Committee  of  Fifty,  1893-100:5,  by  John  S.  Billings,  Charles  W.  Eliot 
Henry  W.  Farnam,  Jacob  li.  Greene,  and  Francis  G.  Peabody,  1905. 

*  The  role  of  alcohol  as  a  predisposing  cause  of  disease  has  already  been  noted 
It  has  long  been  known  that  drunkards  have  a  very  slim  chance  of  recovery  whai 
attacked  by  pneumonia,  and  it  is  noted  also  that  the  mortality  among  moderatt 
drinkers  is  higher  than  among  total  abstainers.  This  fact  has  long  beer 
known  to  life-insurance  companies  as  holding  good  for  many  diseases  othei 
than  pneumonia.    Osier:  Modern  Medicine,  Vol.  II,  p.  628. 

c  Metchnikoff :  The  New  Hygiene,  p.  25. 

^  See  ••  Twonty-sixth  Annual  Report  of  Massachusetts  Bureau  of  Labor,"  1905 

*  Ditman,  loc.  cit,  p.  47. 
f  See  John  Iluber,  M.  D.,  "  Predisposition  to  tuberculosis,"  The  Medical  NewB 

December  20,  1903,  p.  12.     Also  reports  of  Phlpps  Institute,  Philadelphia. 

'  See  Boies's  various  works,  the  "  Reports  of  the  Committee  of  Fifty,"  and  Re 
port  of  the  Massachusetts  Bureau  of  Labor  Statistics,  1895. 

^  See  Henry  Smith  Williams,  M.  D.,  "Alcohol  and  the  Individual."  McClure'l 
Magazine,  October,  1908,  pp.  704-712.  i 


^isHEH.]  NATIONAL  VITALITY.  711 

ispects  of  the  problem.  The  investigation  covered  a  period  of  about 
liree  years  and  was  carried  on  under  the  general  direction  of  Prof. 
[lenry  W.  Farnam,  of  Yale  University.  The  general  conclusions  of 
his  investigation  were  that  of  the  poverty  which  came  under  the 
lotice  of  the  charity  organization  societies  about  25  per  cent  could 
je  traced  directly  or  indirectly  to  the  use  of  liquor;  of  the  poverty 
found  in  almshouses,  about  37  per  cent.  In  the  investigation  of 
^rime,  the  conclusion  was  reached  that  liquor  was  a  first  cause  in  31 
wv  cent  of  the  criminals  studied,  and  that  it  entered  in  as  a  cause, 
iirectly  or  indirectly,  in  50  per  cent. 

The  investigation  made  by  the  JNIassachusetts  bureau  of  statistics  of 
abor  in  1895  indicated  the  following  percentages  due  to  alcoholism: 

Per  cent. 

Jrime 84.  41 

?aiu>erism 48 

insanity 35 

Several  English  life-insurance  companies — the  Sceptre,  the  United 
Kingdom,  and  General  Provident  and  others — have  found  by  their 
statistics,  running  over  forty  years,  that  abstainers  have  a  death  rate 
ibout  23  per  cent  lower  than  nonabstainers."  Since  the  figures  of  the 
Mutual  Life  Insurance  Company  of  New  York  ^  give  the  same  advan- 
tage to  American  abstainers  (23  per  cent  lower  death  rate),  it  seems 
fair  to  take  the  available  computations  of  the  English  life  insurance 
ompanies  as  a  basis  for  estimating  the  saving  of  life  that  would 
result  in  the  United  States  if  individuals  should  decide  to  give  up  the 
jse  of  alcohol.  It  should  be  remembered,  however,  that  the  favorable 
3gure  of  total  abstainers  is  partly  due  to  the  fact  that  as  a  class 
hey  practice  personal  hygiene  in  all  its  forms. 

A  basis  for  computing  the  sickness  that  might  be  saved  by  total 
ibstinence  is  furnished  by  comparison  between  the  sick  rates  of 
abstaining  and  nonabstaining  societies,  made  b}^  Mr.  H.  Dillon 
Grouge,  public  actuary  of  South  Australia,  in  1892.  He  found  that 
:he  average  weeks  of  sickness  in  three  societies  of  abstainers  was 
1.248;  in  three  societies  of  nonabstainers  the  average  weeks  of  sick- 
less  was  2.317  (lacking  only  one-sixth  of  being  twice  as  much). 

Absinthe  in  France  has  become  almost  as  clearly  a  cause  of  national 
degeneration  as  opium  in  China.  Fortunately  for  our  own  country 
:here  exists  here  a  more  determined  effort  than  in  most,  if  not  all 
3ther  nations,  to  be  rid  of  alcoholism.  The  movement  has  been 
(formidable  enough  to  arouse  anxiety  among  those  whose  capital  is 
iinvested  in  breweries,  distilleries,  and  saloons.  The  movement 
reaches  its  maximum  momentum  in  the  west  and  the  south  of  the 
United  States.  It  is  significant  of  the  rapid  change  of  sentiment  in 
regard  to  the  liquor  question  that  physiologists,  physicians,  educators, 
and  publicists  are  now  becoming  so  thoroughly  impressed  with  the 
importance  of  suppressing  the  evils  of  alcohol. 

The  younger  members  of  the  Kaiser's  family  in  Germany  are 
opposed  to  the  German  habits  iji  regard  to  the  use  of  alcohol,  and  the 
son  of  the  Kaiser  chose  for  his  university  one  where  there  was  less 


"  Letter  from  Miss  C.  F.  Stoddard,  secretary  of  the  Scientific  Temperance 
Federation. 

^  "  Effect  of  Total  Abstinence  on  the  Death  Rate,"  by  Joel  G.  Van  Cise,  actu- 
iry  of  the  Equitable  Life  Assurance  Company  of  the  United  States. 


712  BEPORT   OP   NATIONAL,  CONSERVATION   COMMISSION. 

drinkinor  than  at  other  universities.  President  Eliot,  of  Harvard 
University,  has  recently  taken  a  strong  position  against  the  use  of 
alcohol,  even  "  in  moderation." 

Another  common,  though  less  injurious,  source  of  self-poisoning 
is  tobacco,  which  is  known  to  stunt  the  growth  of  the  young,  to  lead 
to  sluggishness  and  weakened  hearts  ("  tobacco  hearts  "),  and  to  cause 
dyspepsia  and  neurasthenia. 

Snuff  taking  has  almost  disappeared  as  a  habit  in  this  country. 
Chewing  tobacco  is  still  common,  though  no  longer  defended  by 
hygienists.  "  Inhaling  "  is  more  common,  though  also  usually  con- 
demned on  grounds  of  health.  Smoking  shows  no  signs,  as  yet,  of 
decreasing.  In  moderation  it  may  not  be  injurious.  There  are  no 
definite  proofs  on  either  side.     But  smokers  are  seldom  moderate. 

Doctor  Seaver,  of  the  Yale  Gymnasium,  found  that  of  the  187  men 
in  the  class  of  1891,  Yale  College,  those  not  using  tobacco  during  the 
college  course  had  gained  over  the  users  of  tobacco  in  weight  32  per 
cent,  in  height  29  per  cent,  in  growth  of  chest  19  per  cent,  and  in  lung 
capacity  60  per  cent." 

Similar  returns  for  the  Amherst  graduating  class  of  1891  showed 
a  gain  by  the  nonusers  of  tobacco  of  24  per  cent  in  weight,  of  37  per 
cent  in  height,  and  of  42  per  cent  in  growth  of  chest.     In  lung  capac- 
ity the  tobacco  users  had  lost  2  cubic  inches  of  air  space,  while  the  ' 
nonusers  had  gained  6^  cubic  inches. 

The  somewhat  injurious  effect  of  tea,  coffee,  and  condiments, 
though  less  than  many  other  evils,  should  be  included  in  any  list 
of  the  imperfections  in  respect  to  hygiene  of  existing  habits  of  life. 

Section  6. — Activity  hygiene. 

Only  a  generation  ago  there  were  scarcely  any  gymnasia  in  this 
country,  but  to-day  the  importance  of  regular  exercise  and  bathing  is 
recognized  by  everyone.  This  is  far  from  saying,  however,  that  this 
important  method  of  conserving  our  vital  resources  has  more  than 
begun  to  be  exploited. 

First,  the  bath  for  the  well-to-do,  and,  latterly,  the  public  baths  for 
the  poor,  have  given  all  an  opportunity  to  obtain  the  cleansing  and 
healing  agency  of  water.  And  in  recent  years  the  application  of 
baths  has  become  a  science.* 

Baths  may  be  used  as  social  agents.     Judge  Ben.  B.  Lindsey,  of 
the  Denver  juvenile  court,  insists  that  every  child  must  take  a  bath  \ 
before  appearing  in  the  court  room.     Neutral  baths,  i.  e.,  baths  regu 

<*  Doctor  Anderson,  of  the  Yale  Gyranasinm,  finds  similar  results.  He  also 
points  out  a  statistical  pitfall  into  which  some  investigators  have  fallen.  This 
Is  the  common  statistical  fallacy  of  selection.  There  are  two  great  groups  of' 
college  students,  roughly  distinguished  as  athletes  and  scholarship  men.  (See 
Doctor  Sargent,  "  Physitjne  of  scholars,  athletes,  and  the  average  student,"  i 
Popular  Science  Monthly,  September,  1908.)  Smoking  is  more  common  in  the 
former  group.  They  are  not  athletes  because  they  smoke,  but  smoke  because 
they  are  athletes.  The  raw  figures  of  smokers  and  nonsmokers  usually  show 
that  the  smokers  have  better  physical  development,  but  if  we  compare  the 
smoking  athletes  with  the  nonsmoking  athletes  and  the  smoking  scholarship 
men  with  the  nonsmoking  scholarship  men  the  results  are  quite  different.  For 
similar  statistical  fallacies,  due  to  failure  to  subgroup  properly,  see  Mayo- 
Smith,  "  Statistics  and  Sociology,"  Macmillan,  1895. 

'See  J.  H.  Kellogg,  M.  D.,  "Rational  Hydrotherapy,"  Philadelphia,  1904. 


SHBB.]  NATIONAL.  VITALITY.  713 


ited  to  the  temperature  of  the  body,  have  been  found  valuable  in 
blaxing  the  nerves  of  the  body,  and  even  in  the  treatment  of  mental 
isease. 

As  to  exercise,  a  healthy  organism  must  call  into  play  every  func- 
on  daily,  both  mental  and  physical.  One  of  the  evils  of  the  division 
f  labor  which  civilization  has  brought  is  that  the  sedentary  worker 
oes  not  have  enough  physical  exercise,  but  too  much  mental  exercise, 
hile  the  situation  is  just  the  opposite  in  the  case  of  the  workingman. 
A  well-known  physical  director,  now  nearly  50  years  old,  writes  me 
lat  he  has  this  year  taken  up  systematic  physical  training,  which 
e  has  neglected  for  several  years  because  of  pressure  of  work.  As 
result  his  weight  has  risen,  his  chest  and  arm  girths  have  increased, 
hile  his  waist  girth  has  decreased,  and  he  is  conscious  of  decided 
nprovement  in  memory  and  in  sleep.  This  instance  is  cited  as  an 
sample  of  the  physical  development  possible  in  a  man  of  middle 
ye. 

In  its  bearing  on  exercise,  the  growth  of  modern  athletics  and  its 
Tects  on  the  physical  ideals  of  men  and  women  is  to  be  welcomed, 
he  revival  of  the  Ol3^mpian  games  and  the  spread  of  popular  par- 
cipation  in  such  outdoor  sports  as  golf,  tennis,  boating,  and  horse- 
ick  riding  have  all  had  their  share  in  building  up  a  new  health 
eal.  Thus  we  are  getting  away  from  the  mediaeval  idea  of  morti- 
jation  of  the  flesh  and  approaching  more  closely  the  Greek  concep- 
on  of  a  beautiful  body  as  the  covering  for  a  beautiful  soul.  The 
reeks  lifted  their  sports  to  a  higher  level  than  ours  by  surrounding 
lem  Avith  imagination  and  making  them  a  training  in  aesthetics  as 
ell  as  in  physical  excellence.'*  The  American  idea  is  at  present  too 
losely  connected  with  mere  winning,  and  not  enough  with  develop- 
ent.  In  the  past  the  physical  athlete  has  been  too  much  associated 
[ith  the  pugilist,  and  has  been  looked  down  upon  as  having  merely 
nite  strength.  The  intellectual  type,  on  the  other  hand,  has  been 
ntent  wholly  to  neglect  bodily  development. 

T  In  the  last  three  years  considerable  evidence  has  accumulated  to 

low  that  the  sitting  posture  of  the  sedentary  man  tends  sooner  or 

ter  to  produce  nervous  prostration,  and  that  the  ordinary  chair 

vites  to  this  effect  by  producing  a  bent  attitude,  both  in  the  forward 

jrection  and  in  the  shoulders.     The  effect  of  the  former  is  to  tax 

e    splanchnic    nerves    and    congest    the    portal    circulation.     The 

'lanchnic  area,  which  is  enormous,  is  a  sort  of  overflow  tank  for  the 

ood.    If  the  muscles  of  this  area  are  allowed  to  relax  through  im- 

•oper  position  in  standing  or  sitting,  the  result  is  the  stagnation 

the  blood  in  the  abdomen,  and  this  in  turn  results  in  a  vicious 

Ircle  of  evil  effects.     Since  much  of  our  life  is  spent  in  chairs,  this 

ct  is  of  no  small  importance.    Improperly  made  school  chairs  and 

ihygienic  habits  of  sitting  in  them  may  start  off  millions  of  young 

'ves  with  round  shoulders,  curved  spines,  and  the  later  effects  of 

)rtal  congestion. 

Exercise  of  mind  does  not  simply  mean  exercise  of  intellect.    The 

lotions  and  the  will  are  equaLy  a  part  of  a  well-developed  healthy 

Jan.    Late  in  life  Darwin  had  occasion  to  lament  the  fact  that  his 

fictional  capacity  had  become  cramped  because  he  had  exercised 

"See  G.   L.   Dickinson:  "  Ttie  Greek  View  of  Life,"  New   York    (McClure, 
lillips),  1906,  pp.  131-134. 


714  REPORT   OF    NATIONAL.  CONSERVATION    COMMISSION. 

his  mind  in  his  own  branch  of  work  to  the  exclusion  of  other  things. 
Whatever  our  ideas  of  theology  or  religion  are,  it  is  true  that  we  all 
ought  to  have  a  spiritual  sense.  Some  men  lack  this  spiritual  sense 
and  are  incapable  of  understanding  the  spiritual  experience  of  others: 
"  For  toil  without  purposeful  and  occupied  leisure  is  unfilled  pur- 
pose, a  process  arrested  midway."  »  Worry  and  fear  are  unhealthy, 
llope,  courage,  enjoyment,  and  an  optimistic  attitude  generally  are 
healthy.^ 

The  ordinary  workingman  works  two  or  three  hours  too  much 
every  day.  Nearly  every  man  overworks  himself,  takes  insufficient 
rest  and  recreation,  and  worst  of  all,  cuts  off  his  normal  portion  ol 
sleep.  Fatigue  ought  to  be  "  avoided  like  poison,"  because,  physio- 
logically, it  is  really  poison.  Worry,  fear,  and  anger  also  produce 
poisons  harmful  to  the  human  body.  This  is  suggested  at  least  by 
the  effect  upon  a  nursing  infant  of  violent  paroxysms  of  anger,  or 
periods  of  intense  fear  or  anxiety  on  the  part  of  its  mother.  The 
intense  exhaustion  which  follows  such  paroxysms  is  another  case  in 
point. 

An  animal  lives  a  much  more  healthy  life  than  the  average  man, 
because  an  animal  follows  instinct,  while  a  man  to  a  large  extent 
endeavors  to  substitute  for  his  instincts  rules  which  are  very  often 
false.  One  of  the  instincts  constantly  disregarded  by  man  is  that 
which  finds  its  expression  in  fatigue.  The  ordinary  man  working 
for  some  one  else  is  compelled  to  toil  beyond  the  fatigue  limit;  and. 
on  the  other  hand,  if  a  man  is  in  business  for  himself,  he  does  the 
same  thing  of  his  own  will.  Although  no  one  knows  what  sleep  is. 
it  serves,  according  to  the  best  theory,  to  eliminate  poisons  and  to 
rebuild  tissue.  With  rest  is  closely  associated  recreation.  Play 
practices  the  power  of  a  child's  mind,  while  contest  among  children 
develops  self-control."  Similarly,  adults  are  rested  b}'  phiy  or  recrea^ 
tion,  their  minds  and  bodies  are  relaxed,  while  their  contests  of  mimic 
warfare  develop  their  powers  of  will  and  effort. 

Section  7. — Sex  hygiene. 

One  element  in  personal  hygiene  concerns  the  sex  relation.  Thi^ 
can  not  be  treated  under  other  heads,  for  the  sex  relation  is  so  purely 
a  personal  and  individual  one.  From  its  normal  utilization  there  u 
little  to  fear,  but  from  the  effects  of  illegitimate  sexual  practices  thfj 
world  suffers  enormous  yearly  losses.  It  is  hardly  possible  to  havtj 
promiscuous  sex  relations  out  of  wedlock  without  contracting  one  oi; 
the  other  of  the  serious  venereal  diseasCvS.  The  best  authorities  report 
that  "  every  prostitute  is  diseased  some  of  the  time  and  some  prosti- 
tutes are  diseased  all  of  the  time." 

One  disease,  syphilis,  infects  the  blood  and  therewith  all  parts  oJj 
the  body.     For  months  after  infection  with  this  disease  the  indi- 

<»  Simon  N.  Patten :  "  The  New  Basis  of  Civilization,"  New  Yorlj  (Macniillan)| 
1907,  p.  15S.  I 

'' Du  Bois:  "Ttie  Psycliic  Treatment  of  Nervous  Disorders,"  New  Yorli,  1905! 
465  pp.  Saleeby:  "Worry,  the  Disease  of  the  Age,"  New  York  (Stolves),  1907 
Sidis:  "The  Psychology  of  Suggestion,"  New  York  (Appleton),  1899,  386  pp 
Schofleld :  "  The  Force  of  Mind,  or  the  Mental  Factor  in  Medicine,"  LondoE 
(Churchill),  1902,  309  pp. 

"  See  President  G.  Stanley  Hall :  "  Play  and  Dancing  for  Adolescents,"  Inde 
pendent,  reprinted  in  "  Mind  and  Body,"  Vol.  XIV.  1907,  pp.  43-48. 


nsHER.l  NATIONAL  VITALITY.  715 

ividiial  may  communicate  it  by  a  kiss  as  well  as  by  cohabitation;  and 
larticles  moistened  by  his  secretions — towels,  drinking  glasses,  pipo5, 
i?,tc. — may  also  convey  the  infection.  "While  under  proper  treatment 
the  disease  is  not  always  dangerous  to  life  in  the  earlier  years,  yet 
■:he  possibilities  of  transmitting  the  contagion  should  forbid  marriage 
for  at  least  three  years. 

\  The  most  serious  results  of  syphilis,  some  authorities  say,  may 
appear  years  after  its  acquisition,  when  the  individual  has  been 
lulled  into  a  false  sense  of  security  by  long  freedom  from  its  mani- 
festations and  considers  himself  cured.  Many  cases  are  practically 
ncurable.  Some  are  fatal  in  spite  of  treatment.  It  may  attack  any 
)rgan  of  the  bod}'.  Among  the  many  diseases  to  which  it  may  lead 
lire  apoplex}'',  paralysis,  insanity,  and  locomotor  ataxia ;  and  these 
)ften  appear  after  the  man  has  acquired  a  family  that  is  dependent 
ipon  him  for  support. 

The  leading  insurance  companies  refuse  to  insure  the  life  of  a 
syphilitic  person  for  four  or  five  years  after  the  disease  was  con- 
racted,  and  then  only  upon  special  terms,  for  their  records  prove 
that  syphilis  shortens  life. 

That  the  syphilitic  parent  may  transmit  the  disease  to  his  offspring 
s  common  knowledge.  Some  of  his  children  are  destroyed  by  the 
inherited  disease  before  birth;  others  are  born  to  a  brief  and  sickly 
;pan  of  life;  others  attain  maturity,  seriously  handicapped  in  the 
race  of  life  by  a  burden  of  ill  health,  incapacity,  and  misery  produced 
3y  the  inherited  taint,  while  still  others  escape  these  evil  effects.'* 

Forcl,  in  Die  Sexuelle  Frage,  shows  that  even  Weissmann  does  not 
ieny  the  possibility  of  poisoning  the  germ  cell  and  so  transmitting 
iome  "'  acquired  characteristics,"  as  in  alcoholism  and  venereal  poison- 
ng.  One  of  the  saddest  facts  in  both  cases  is  that  the  parent  may 
sscape  and  the  children  reap  the  results  in  insanity,  tendency  to  con- 
sumption, and  prostitution. 

Another  disease — 

Gonorrhea,  while  usually  cured  without  apparent  loss  of  health,  has  always 
;erious  possibilities;  it  kills  about  1  in  200;  it  impairs  the  sexual  power  and 
ertility  of  a  much  larger  number ;  it  often  produces  urethral  strictures,  which 
ater  may  cause  loss  of  life." 

The  persistence  of  gonorrhea  in  the  deeper  parts  long  after  it  is  outwardly 
.:ured  leads  to  the  unsuspected  communication  of  the  disease  to  women  with 
vhom  the  individual  may  cohabit.  Much  of  the  surgery  performed  upon  women 
^las  been  rendered  necessary  by  gonorrhea  contracted  from  the  husband.  Should 
ihe  while  infected  with  this  disease  give  birth  to  a  child,  the  baby's  eyes  may 
')e  attacked  by  the  infection,  sometimes  with  immediate  loss  of  sight  Probably 
!5  per  cent  ^  of  the  blindness  of  children  is  thus  caused. 

Dr.  Prince  A.  Morrow  says : 

This  social  danger  comes  from  frequent  Introductions  of  these  diseases  into 
narriage.  The  frequency  of  marital  contamination  does  not  admit  of  exact 
nathematical  expression,  as  both  social  sentiment  and  professional  ethics  unite 
0  cover  up  and  conceal  it.  Possibly  10  per  cent  of  men  who  marry  infect  their 
vives  with  venereal  disease. 

o  Circular  No.  2,  "  Self-protection,"  Chicago  Society  of  Social  Hygiene,  pp.  7-8. 

*"The  average  of  a  great  many  statistics  shows  that  one-fourth  of  all  blind 
ioersons  owe  their  attliction  to  the  effects  of  ophthalmia  of  the  new  born."  Chas. 
■3.  May,  M.  D.,  ophthalmic  and  aural  surgeon,  New  York,  Transactions  of  Amer- 
ican Societies  of  Sanitary  and  Moral  Prophylaxis,  Vol.  II,  1908. 

S.  Doc.  419,  61-2 7 


716  REPORT   OF    NATIONAL  CONSERVATION    COMiMlSSlON. 

The  report  of  the  Committee  of  Seven  (New  York)  shows  that  in 
private  practice  nearly  30  per  cent  of  venereally  infected  women  were 
contaminated  by  their  husbands.  The  report  of  the  Committee  on 
Sanitary  and  Moral  Prophylaxis  (Baltimore)  shows  that  nearly  40 
per  cent  of  the  infections  in  women  seen  in  i)rivate  practice  were  com- 
municated in  married  life.  "  My  own  observations  at  the  New  York 
Hospital,  extending  over  a  period  of  several  years,  would  indicate 
that  fully  70  per  cent  of  all  women  who  came  there  for  treatment  of; 
syphilis  were  respectable  married  women  who  had  been  infected  by 
their  husbands," "  ^  .  .         .       .       ' 

Observation  shows  that  gonorrhea  is  markedly  intensified  in  viru- 
lence and  danger  to  the  woman  in  fulfilling  the  functions  for  wliich 
marriage  was  instituted.  Pregnancy  and  childbearing  open  the  way 
for  germs.  One  of  the  most  constant  effects  of  gonorrhea  in  women 
is  permanent  and  irremediable  sterility.  Fifty  per  cent  of  gonor- 
rheally  infected  women  become  absolutely  sterile,  and  a  still  larger 
percentage  sterile  after  the  first  child  is  born  (one-child  sterility). 
Noeggerath  found  in  81  gonorrheal  women  49  entirely  sterile.  In  80' 
sterile  marriages  Kehrer  found  45  caused  by  inflammatory  changes  of 
gonorrheal  origin.  It  is  estimated  that  the  husband  is  directly  re- 
sponsible for  20  to  25  per  cent  of  sterility  from  his  inability  to  pro- 
create as  the  result  of  gonorrhea.  In  addition  the  husband,  though 
not  sterile  himself,  may  infect  his  wife,  rendering  her  sterile.  The 
disease  is  ultimately  responsible  for  about  70  to  75  per  cent  of  all 
sterility  in  married  life,  which  is  not  of  choice,  but  of  incapacity. 
Lier-Ascher's  careful  statistics  place  this  proportion  at  71.2  per  cent. 
These  figures  relate  to  absolute  sterility.  The  chief  social  danger  of 
gonorrhea  as  a  dejoopulating  factor  is  the  creation  of  secondary  steril- 
ity, or  what  has  been  expressively  termed  "one-child  sterility."  The 
large  percentage  of  marriages  in  which  one  child  represents  the  total 
fecundity  of  the  family  justifies  the  conclusion  that  this  sterility  is 
in  many  cases  not  of  choice,  but  of  procreative  capacity  extinguished 
b}'  gonorrhea. 

'  In  addition,  the  inflammation  set  up  in  the  maternal  organs  may 
render  the  mother  a  permanent  invalid  or  compel  her  to  submit  to  a 
mutilating  operation  to  save  her  life. 

Gynecologists  furnish  statistical  evidence  showing  that  80  per  cent 
of  tiie  deaths  due  to  inflammatory  diseases  peculiar  to  women  ^  and 
about  70  per  cent  '^  of  all  the  work  done  by  specialists  for  diseases  of 
women  is  caused  by  gonorrhea. 

In  addition  to  the  effect  of  a  low  protein  diet  on  endurance,  already 
discussed,  and  on  general  health,  its  relation  to  the  sexual  life  should 
be  mentioned.  Experiments  on  this  subject  seem  to  show  that  exces- 
sive meat  eating  and  excessive  protein  intake  tend  to  irritate  the 
sexual  organs  and  to  produce  abnormal  sexual  desire  just  as  they  do 

"Morrow,  Social  Diseases  and  Jlarriage,  Pliiladelpliia  (Lea),  1904. 

^  III  report  of  special  coniuiittce  of  the  Aniericau  Medical  Association,  1901, 
Plunniston  says:  "Ninety  per  cent  of  iuflaniniatory  troubles  of  uuilornal  organs 
are  attributable  to  gonorrhea."  Price  says:  "That  in  over  1,000  operations  for 
pelvic  trouble  95  per  cent  were  attributable  to  this  infection."  Another  author- 
ity gives  a  percentage  of  7."). 

<' Address  of  Doctor  Cleveland,  president  of  American  Gynecological  Society, 
at  National  Congress  of  Anieiican  Physicians  and  Surgeons,  Washington,  1907.1 


fi    ni:r..]  NATIONAl.   VITALITY.  717 

a  desire  for  alcoholic  stimulation.    This  fact  is  of  importance  in  pre- 
venting secret  vice  among  the  yoimg. 

Thanks  to  the  efforts  of  a  few  farsightod  men  like  Dr.  Prince  A. 
]\rorrow,  Prof.  C.  R.  Henderson,  and  Mr.  Edward  Bok,  these  subjects 
are  being  given  some  of  the  publicity  they  deserve.  Reticence  on 
these  subjects  is  justified  only  so  far  as  it  makes  for  youthful  inno- 
CH'nce.  But  ignorance  is  not  innocence;  on  the  contrary  it  is  the 
surest  road  to  guilt. 

Section  8. — Personal  hygiene  in  general. 

'  Personal  hygiene  is  only  beginning  to  be  generally  exploited.  Most 
persons  leave  their  health  to  be  attended  to  by  physicians  and  health 
officers,  just  as  many  people  leave  their  religion  in  the  hands  of  a 
priest  or  clergyman.  So  far  as  practiced  at  all,  personal  hygiene  has 
been  confined  chiefiy  to  invalids  and  athletes.  Even  by  them  it  is 
usually  practiced  to  tide  over  an  illness  or  to  prepare  for  a  contest. 
But  it  is  manifest  destiny  that  a  wise  economy  of  vitality  will  sooner 
or  later  be  practiced.  Waste  of  vital  resources  is  as  irrational  as 
waste  of  natural  resources.  Neither  is  inexhaustible  and  both  must  be 
conserved.  Thoughtlessness  and  ignorance  are  the  reasons  for  the  ap- 
palling waste  of  both  now  going  on.  Even  people  who  do  not  defi- 
antly abuse  their  strength  by  definite  excesses  are  liable  to  waste  i»t 
gradually.  Slightly  unhygienic  habits  grow,  and  their  effects  are 
doubtless  cumulative.  It  is  well  known  that  even  a  so-called  "  venti- 
lated house,"  if  lived  in  long  enough  without  sufficient  outdoor  life, 
may  induce  tuberculosis.  This  must  be  through  the  repetition  of  an 
infinitesimal  injury  produced  through  each  respiration  eighteen  times 
a  minute  for  twenty-four  hours  a  day  for  half  a  lifetime. 

So  with  the  use  of  food  preservatives.    Food  manufacturers  have 
laid  much  emphasis  on  the  fact  that  preservatives  are  "  harmless  " 
because  used  in  small  quantities,  but  Doctor  Wiley  has  raised  the 
question  whether  even  very  small  quantities  of  these  preservatives, 
if  used  continuously  for  a  sufficient  length  of  time,  are  not  injurious. 
!The  same  applies  to  the  repetition  of  preservatives  in  a  large  number 
i  of  different  foods.    If  only  one  particular  food  contained  a  preserva- 
tive, the  effect  would  be  relatively  negligible;  but  as  one  food  after 
'another  has  become  adulterated,  the  human  stomach  is  made  the  daily 
receptacle  of  many  times  the  "  harmless  "  amount  in  any  one  par- 
ticular food.    The  obstacles  to  hygiene  which  have  accumulated  with 
I  civilization  are  almost  as  numerous  and  as  small  as  the  barnacles 
which  impede  a  ship.    To  remove  them  is  in  large  part  to  "  return  to 
nature."    Many  of  the  inventions  of  which  civilization  boasts  have 
had  an  unhygienic  side.     The  invention  of  houses  has  made  it  pos- 
sible for  mankind  to  spread  all  over  the  globe,  but  it  is  responsible 
for  tuberculosis,  especially  after  glass  was  devised,  which  while  let- 
ting in  the  light  keeps  out  the  air.     The  invention  of  cooking  and 
preparing  foods  has  widened  the  variety  of  man's  diet,  but  has  led  to 
the  decay  of  his  teeth."    The  invention  of  the  alphabet  and  printing 

°  See  Ottofy,  "  The  Teeth  of  the  Igorots,"  Dental  Cosmos,  July,  11)08,  where 
it  is  shown,  statistically  si>eaking,  that  the  teeth  of  Americans  are  "  ten  limes  as 
bad  as  those  of  the  Igorots,"  while  the  civilized  Filipinos  have  teeth  as  bad  as 
those  of  Americana. 


718  REPORT   OF    NATIONAL  CONSERVATION   COMMISSION. 

has  made  possible  the  accumulation  of  knowledge,  but  it  has  produced 
eye  strain  with  all  its  attendant  evils.  The  invention  of  chairs  has 
added  to  human  convenience,  but  has  led  to  sj^inal  curvature  and 
abdominal  congestion.  The  device  of  a  division  of  labor  has  added 
to  wealth,  but  has  destroyed  the  normal  balance  of  mental  and  phys- 
ical work,  recreation,  and  rest.  Similar  fault  may  be  found  with 
clothing,  especially  corsets,  shoes,  and  hats,  and  with  numerous  other 
contrivances.  Yet  it  would  be  foolish,  even  if  it  were  possible,  to 
attempt  to  "  return  to  nature  "  in  the  sense  of  abolishing  civilization. 
We  must  not  go  backward,  but  forward.  The  cure  for  eye  strain  is 
not  in  disregarding  the  invention  of  reading,  but  in  introducing  the 
invention  of  glasses.  The  cure  for  tuberculosis  is  not  in  the  destruc- 
tion of  houses,  but  in  devices  for  ventilation.  It  is  a  little  knowledge 
that  is  dangerous.  Civilization  can,  with  fuller  knowledge,  bring  its 
own  cure  and  make  the  "  kingdom  of  man  "  far  larger,  even  in  respect 
to  hj'gienic  conditions,  than  "  nature  "  people  can  ever  dream  of. 

Unhygienic  customs  and  fashions  are  exceedingly  slow  to  yield, 
but  they  do  yield  in  the  end.  It  should  be  the  part  of  intelligent  men 
to  lead  in  hygienic  reform,  not  by  intolerant  and  impatient  abuse  of 
their  fellow-men,  but  by  the  quiet  force  of  example.  The  intolerant 
and  impatient  reformer  does  incalculable  harm,  for  he  takes  no  ac- 
count of  that  subtle  perversity  of  human  nature  which  resents  his 
interference.  Equally  harmful  is  the  man  who  seeks  only  to  imitate 
the  crowd,  who  condones  the  vices  of  his  time  and  country. 

But  we  must  always  bear  in  mind  what  has  been  called  the  "  psy- 
chology of  the  crowd."  Tarde,  Le  Bon,  Baldwin,  Ross,  and  others 
have  shown  that  society  is  largely  ruled  by  customs  which  grow  out 
of  imitation.  In  order  that  any  social  custom  shall  be  changed, 
initiative  is  necessary.  The  upper  classes  should  take  the  lead,  for  any 
reform  will  spread  many  times  more  quickly  when  the  initiative  comes 
from  above  than  when  it  comes  from  below.  Western  civilization  has 
made  its  marvelously  rapid  progress  in  Japan  for  the  simple  reason 
that  the  Mikado  approved,  and  marvelously  slow  progress  in  China 
for  the  simple  reason  that  the  Empress  disapproved. 

We  find  the  same  principle  at  work  in  the  progress  of  medicine. 
Hydrotherapy  originated  with  a  peasant  and  required  three  centuries 
to  come  into  vogue.  The  use  of  sour  milk,  on  the  other  hand,  has  been 
advocated  only  during  the  last  two  or  three  years,  but  the  initiative 
came  from  Metchnikoff,  one  of  the  foremost  of  medical  scientists. 
The  consequence  is  that  the  so-called  "sour-milk  craze"  has  already 
led  to  great  industries  and  affected  the  business  of  groceries,  soda- 
water  fountains,  and  even  liquor  saloons. 

The  change  constituting  hygienic  reform  will  be  brought  about  most 
rapidly  by  the  influences  on  the  young.  If  children  in  their  homes 
and  schools  are  given  proper  models  for  imitation,  the  public  opinion 
which  they  will  form  may  make  a  revolution  in  a  single  generation. 
Anyone  who  realizes  the  almost  resistless  force  of  the  principle  of 
imitation,  especially  when  applied  to  children,  will  receive  a  new  sense 
of  the  responsibility  he  takes  in  setting  an  example  to  the  young. 
There  are  three  classes  in  particular  on  whom  the  responsibility  is 
heavy — teachers,  physicians,  and  parents.  If  they  wish  the  child  to 
be  free  from  the  cigarette  habit,  they  must  sacrifice  the  cigar  and  pipe 
habit,  even  though  it  be  true  that  cigars  and  pipes  are  not  injurious  to 
adults.    They  may  believe  this,  but  the  children  will  not    The  same 


nsHKR.]  NATIONAL  VITALITY.  719 

principle  applies  to  other  and  more  serious  infractions  of  the  laws  of 
health.  It  is  probably  through  the  love  of  the  next  generation,  rather 
than  through  an}^  selfish  care  for  the  present,  that  men  and  women 
now  living  will  take  the  most  pains  to  secure  the  best  results  in 
bringing  about  the  change  in  living  conditions  for  which  every 
hj'gienist  hopes. 

Chapter  X. — Are  hygienic  measures  eugenic f 

Section  1. — Prolongation  of  weak  lives. 

We  have  discussed  two  factors  which  cooperate  to  produce  vitality, 
namely,  heredity  and  hygiene;  and  two  corresponding  methods  of  im- 
proving vitality,  namely,  by  utilizing  a  possible  science  of  eugenics 
on  the  one  hand  and  by  utilizing  the  existing  science  of  hygiene  on 
the  other.  The  question  now  arises,  Are  these  two  methods  in  conflict 
with  each  other?  It  is  charged  that  hygiene  prolongs  the  lives  of  unfit 
and  defective  classes.  We  have  already  seen  that  in  Indiana,  institu- 
tional care  of  the  insane  has  prolonged  the  average  insane  lifetime  by 
some  eight  years.     Referring  to  the  insane,  Dr.  Charles  Dana  says: 

For  tweuty-five  years  the  explanation  of  tliis  increase  in  statistics  of  insanity 
Las  been  that  more  cases  were  observed  and  more  victims  kept  in  institutions 
than  formerly ;  and  this  is  still  the  explanation.  It  is  my  opinion,  however, 
that  the  incrense  is  a  real  one,  and  it  is  one  to  be  expected  not  only  from  the 
streniiousness  of  modern  life  and  increase  of  city  population,  but  also,  because 
more  feeble  children  are  nursed  to  maturity  and  mox-e  invalid  adolescents  are 
kept  alive  to  propagate  weakly  constitutions  or  to  fall  victims  themselves  to 
alienation,  the  period  of  life  susceptible  to  insanity  is  longer. 

A  fourth  of  the  cases  of  insanity  is  due  to  so-called  "  moral  causes :  "  Emo- 
tional strain,  shocks,  and  vicious  indulgences.  But  moral  causes  are  not  sufficient 
to  cause  insanity  if  the  individual  has  a  strong  constitution.  Insanity  is  increased 
in  part,  then,  because  we  are  saving  too  many  lives  by  the  careful  regulations 
of  our  health  boards.  Hence,  those  who  are  working  so  enthusiastically  and 
nobly  and  successfully  in  preventing  disease  achieve  results  which  carry  serious 
responsibilities  for  the  State." 

It  is  true  that  we  prolong  the  lives  of  the  insane  and  defective 
classes,  and  that  they  thus  make  a  greater  burden  on  society.  We 
should  see  to  it  that  certain  of  these  classes  are  not  permitted  to  prop- 
agate their  kind.    This  point  has  been  explained  in  Chapter  VI. 

It  is  further  claimed  that  infant  mortality  is  but  the  operation  of 
]natiiral  selection  and  should  not  be  interfered  with  if  we  are  to  keep 
up  the  vital  power  of  the  race.  Preventive  medicine  has  certainly 
prolonged  the  lives  of  infants  or,  at  any  rate,  of  children  in  general.'' 
But  has  this  weakened  the  race?  It  is  pointed  out  that  the  mortality 
later  in  life  has  not  decreased,  and  that  in  some  cases  it  has  even 
tended  to  increase.  But  this  fact  can  be  explained  in  either  of  two 
ways.    One  is  on  the  hypothesis  of  the  extension  of  the  lives  of  weak 

a  "  Psychiatry  in  its  relation  to  the  other  sciences,"  by  Charles  L.  Dana,  M.  D.. 
before  the  section  on  psychiatry  at  the  International  Congress  of  Arts  and 
Science,  at  St.  Louis,  September,  1904.  See  also  Janus  in  Modern  Life,  by  W.  M. 
Flinders  Petri,  New  York  (Putnam),  1907. 

*  See  Edwin  Graham,  "Infant  mortality,"  Journal  American  Medical  Asso- 
, elation,  September  26,  1908;  also  Edward  B.  Phelps,  "  Statistical  study  of  infant 
jmortality,"  Quarterly  Publications  American  Statistical  Association,  September, 
1908.  Mr.  Phelps  shows  that  infant  mortality  has  declined  less  than  is  com- 
monly believed,  and  that  its  apparent  decline  is  often  due  to  inaccurate  and 
misleading  statistics. 


720  REPORT   OF    NATIONAL  CONSERVATION    COMMISSION. 


I 


infants.  Tho  other  is  on  the  hypothesis  of  the  comparative  neglect 
of  hygiene  among  adults.  It  is  surprising  that  this  latter  alternative 
has  not  been  given  due  consideration. 

Every  detail  of  infant  life  has  latterly  been  made  the  subject  of 
special  study,  and  every  mother  of  common  intelligence  has  tried  to 
learn  and  to  apply  the  results  of  that  study.  The  times  of  the  baby's 
meals,  the  quantit}'^  of  its  feeding,  the  modification  and  sterilization  of 
cow's  milk,  the  hours  of  sleep,  the  ventilation  of  sleeping  rooms,  and 
other  innumerable  details  are  now  attended  to  with  scrupulous  care. 
The  change  in  these  respects,  even  within  the  memory  of  most  persons 
now  living,  is  striking.  The  children  have  reaped  the  reward.  Pnit 
n.o  corresponding  change  has  taken  place  in  the  habits  of  the  adult 
population.  Many  families  buy  one  grade  of  milk  for  the  babies, 
and  another  cheaper  grade  for  the  rest  of  the  family.  This  they  re- 
gard as  "economy."  Parents  require  their  children  to  keep  regular 
and  suitable  hours  for  sleep,  but  "  owl  it "  themselves.  They  will 
keep  their  children  out  of  doors,  and  send  them  into  the  country,  but  h 
subject  themselves  to  the  dust,  smoke,  and  close  air  of  the  workroom 
and  places  of  busine^ss.  They  will  not  allow  their  children  to  use 
alcohol  or  tobacco,  or  even  tea  or  coffee,  much  less  opium,  chloral,  or 
other  habit- forming  drugs,  but  they  take  these  themselves  as  a  matter 
of  course.  They  are  now  insisting  on  playgrounds  for  children,  but 
their  own  amusements  are  sought  in  the  unhygienic  theater,  or  maybe 
in  the  saloon  or  immoral  resort.  The  child  is  protected  on  all  sides, 
with  the  result  that  he  sometimes  lives  almost  an  ideal  animal  life, 
with  its  due  proportion  of  amusement,  exercise,  rest,  and  sleep.  The 
parents  themselves  are  tied  down  to  drudgery,  overwork,  worry,  and 
long  hours.  The  difference,  when  we  reflect  upon  it,  is  startling.  AVe 
make  hygiene  paramount  for  our  children;  for  ourselves  we  neglect 
it  totally,  partly  from  the  idea  of  sacrificing  ourselves  for  the  sake  of 
our  children,  partly  from  necessity,  real  or  imagined,  and  partly 
from  the  thraldom  of  habit  already  formed.  With  such  a  contrast 
between  the  recent  improvement  of  hygiene  in  childhood  and  the  lack 
of  improvement  in  middle  life,  one  need  not  wonder  that  the  mor- 
tality of  one  period  has  improved  and  that  of  the  other  has  not.  We 
do  not  need  to  invoke  the  aid  of  the  theory  that  weak  lives  have  been 
more  prolonged  than  strong  lives.  The  moral  is  that  hygiene  should 
not  stop  in  childhood.  It  is  natural  and  proper,  however,  that  the 
first  attempt  to  apply  hygienic  Imowledge  should  begin  with  children. 
It  is  through  children  that  new-  ideas  usually  make  their  way  into 
custom.  "  You  can't  teach  an  old  dog  new  tricks."  Grown  persons 
have  habits  already  formed,  and  when  once  a  habit  is  formed  it  is 
difficult  to  change  it. 

Habits  of  living  among  adults  have  even  grown  worse  in  some 
respects.  Observing  practitioners  comment  on  the  increasing  nervous 
tension  in  modern  life.  The  rush  of  the  railway  train,  the  telephone, 
the  elevator  are  at  once  an  outgrowth  and  an  excitant  of  this  in- 
creased tension.  They  are  life's  pace  makers,  and  the  pace  is  ever 
quickened.  The  health  officer  of  New  York  City  attributes  to  this 
severer  strain  the  increase  of  heart  and  nervous  diseases.  It  would 
be  interesting  to  know  the  relative  prevalence  of  adult  diseases  under 
conditions  of  reposeful  and  exciting  surroundings  and  occupations, 
but  I  know  of  no  investigation  on  this  phase  of  the  subject.  " 


riSHEE.]  NATIONAL  VITALITY.  721 

While  this  report  was  being  written  the  recent  figures  from  Great 
Britain  came  to  hand.  They  show  that  the  tendency  of  the  death 
rates  among  the  later  ages  to  increase  seems  to  have  given  place  to  a 
slightly  opposite  tendency.  The  expectation  of  life  at  ages  40,  60, 
and  80  during  the  decade  of  1891-1900  has  a  little  more  than  held 
its  own  as  compared  with  the  previous  decade. 

Section  2. — Children's  diseases  urppair  loth  fit  and  unfit. 

Another  point  needs  emphasis.  AVhen  it  is  said  that  the  lives  of 
weak  infants  are  prolonged  it  is  commonly  overlooked  that  the  same 
pauses  also  prolong  the  lives  of  the  strong,  and,  reversely,  that  un- 
hygienic conditions  which  tend  to  exterminate  the  weak  tend  also 
CO  shorten  the  lives  of  the  strong.  Bad  hygiene  is  merely  a  common 
jandicap  for  all  classes.  The  burden  of  proof  is  upon  those  who 
jlaim  that  it  has  a  differential  effect  and  increases  the  process  of 
sveeding  out  the  unfit.  This  weeding-out  process  goes  on  whether 
bhere  is  a  great  or  a  small  obstruction  to  overcome.  Bad  air  and 
jhildren's  epidemics  are  the  common  environment  of  all.  While 
:his  must  produce  a  greater  mortality,  it  remains  to  be  shown  that  it 
KTOuld  be  more  selective. 

That  a  high  infant  mortality  does  not  tend  to  lengthen  life,  but 
rather  to  stunt  all  life,  would  seem  to  be  indicated  by  the  evidence, 
50  far  as  it  can  be  interpreted.  Russia,  for  instance,  has  a  high 
nfant  mortality.  If  the  statistics  are  to  be  trusted,  it  is  70  per  cent 
^eater  than  in  the  United  States;  yet  Moscow  and  St.  Petersburg 
lave  a  general  mortality  rate  which  greatly  exceeds  that  of  similar 
;ities  in  this  country. 

It  may  be  that  the  more  unfavorable  the  struggle  for  existence 
he  more  rapidly  will  natural  selection  re^sult  in  improved  vitality. 
3ut  even  if  this  were  true,  it  would  not  imply  that  in  a  more  favor- 
il)le  environment  selection  would  cease.  And  it  may  not  be  true.  It 
nay  be  that  adversity,  if  too  severe,  will  crush  and  injure  the  sur- 
vivor as  well  as  eliminate  the  unfit.  We  do  not  look  for  the  best 
rees  on  the  bleak  mountain  top,  but  in  the  genial  valley.  As  we  go 
ip  the  struggle  for  existence  increases,  until  even  the  sturdiest  fail 
o  thrive  above  the  "  timber  line." 

The  ftirnier  who  tries  to  improve  his  stocli  does  not  select  hardships.  Cold 
ind  starvation  are  now  negligible  quantities  in  the  great  ranches,  and  the  breeds 
hat  were  notable  for  ability  to  withstand  them  give  way  to  varieties  that  may 
e  adapted  to  neither  emergency." 

Venereal  diseases,  hook-worm  disease,  malaria,  and  many  other 
aaladies  shorten  and  weaken  life,  whether  of  weak  or  strong.     Re- 
erring  to  the  racial  degeneration  probably  caused  by  malaria  on  the 
turdy  Greek,  Maj.  Ronald  Ross  said,  in  an  address  before  the  Oxford 
1  viedical  Society,  November  29,  1906 :  * 

Now  what  must  be  the  effect  of  this  ubiquitous  and  everlasting  incubus  of 
i.isease  on  the  people  of  modern  Greece?  Remember  that  the  malady  is  essen- 
ially  one  of  infancy  among  the  native  population.  Infecting  the  child  one  or 
wo  years  after  birth,  it  persecutes  him  until  puberty  with  a  long  succession  of 
ebrile  attacks.     *     *     *     iningine  the  effect  it  would  produce  upon  our  own 


0  Simon  N.  Patten,  The  New  Basis  of  Civilization,  New  York  (Macmillan), 
907. 

^  This  quotation  is  from  Dr.  L.  O.  Howard's  report  to  the  Conservation  Com- 
lission  on  "  Economic  loss  to  the  people  of  the  United  States  through  insects 
tat  carry  disease." 


722  EEPORT   OF    NATIONAL  CONSERVATION    COMMISSION. 

cbildrcn  horo  in  Britain.  •  ♦  *  What  would  be  the  effect  upon  our  popula- 
tion, especially  our  rural  population—upon  their  nuinhers  and  upon  the  health 
and  viper  of  the  survivor?  It  must  be  enormous  in  Greece.  People  often  seem 
to  think  that  such  a  plague  strengthens  a  race  by  killing  off  the  weaker  individ- 
uals; but  this  view  rests  upon  the  luiprovcn  assumjition  that  it  is  really  the 
weaker  children  which  can  not  survive.  On  the  contrary,  experience  seems  tc 
show  that  it  is  the  stronger  blood  which  suffers  most — the  fair,  northern  blood] 
which  nature  attempts  constantly  to  pour  into  the  southern  lands."  If  this  bi 
true,  the  effect  of  malaria  will  be  constantly  to  resist  the  invigorating  inllux 
which  nature  has  provided;  and  there  are  many  facts  in  the  history  of  India. 
Italy,  and  Africa  which  could  bo  brought  forward  in  support  of  this  hypothesis. 
*  ♦  ♦  In  prehistoric  times  Greece  was  certainly  peopled  by  successive  waves 
of  Aryan  invaders  from  the  north.  *  *  *  That  race  reached  its  climax  ot 
development  at  the  time  of  Pericles.  *  •  •  Suddenly,  however,  a  blight  fell 
over  all.  Was  it  due  to  Internecine  conflict  or  to  foreign  conquest?  Scarcely, 
for  history  shows  that  war  burns  and  ravages,  but  does  not  annihilate.  Thebes 
was  thrice  destroyed,  but  thrice  rebuilt.  Or  was  it  due  to  some  cause,  entering 
furtively  and  gradually  sapping  away  the  energies  of  the  race  by  attacking  the 
rural  population,  by  slaying  the  newborn  infant,  by  seizing  the  rising  genera- 
tion, and  especially  by  killing  out  the  fair-haired  descendant  of  the  original 
settlers,  leaving  behind  chiefly  the  more  immunized  and  darker  children  of  their 
captives,  won  by  the  sword  from  Asia  and  Africa?  *  *  *  j  can  not  imagine 
Lake  Kopais,  in  its  present  highly  malarious  condition,  to  have  been  thickly 
peopled  by  a  vigorous  race;  nor,  on  looking  at  those  wonderful  figured  tomb- 
stones at  Athens,  can  I  imagine  that  the  healthy  and  powerful  people  repre- 
sented upon  them  could  have  ever  passed  through  the  anaemic  and  "  splenomega- 
lous  "  infancy  (to  coin  a  word)  caused  by  widespread  malaria.  Well,  I  venture 
only  to  suggest  the  hypothesis,  and  must  leave  it  to  scholars  for  confirmation 
or  rejection.  Of  one  thing  I  am  confident — that  causes  such  as  malaria,  dysen- 
tery, and  intestinal  entozoa  must  have  modified  history  to  a  much  greater  extent 
than  we  conceive. 

Evolution  in  human  society  is  a  wonderfully  complex  thing.  Sur- 
vival of  the  races  has  long  been  dependent  on  a  long  period  of  pro- 
tection of  children  by  parents,  and  may  in  future  even  depend  on 
protection  of  other  kinds.'' 

Section  3. — Fitness  is  relative  to  environment. 

Wliether  or  not  degeneration  is  actually  going  on  is  a  question  for 
which  the  data  are  insufficient  for  us  to  form  an  intelligent  generaliza- 
tion. That  there  are  very  strong  forces  working  in  that  direction  can 
not  be  questioned,  but  there  are  also  very  strong  forces  working  in 
the  opposite  direction.  In  discussing  degeneration,  one  point  must 
be  borne  in  mind  which  has  often  been  forgotten  by  writers  on  the 
subject.  Man's  fitness  to  live  is  relative  to  the  environment  in  which 
he  is  to  live.  If  muscular  strength  decreases,  it  is  not  a  sign  of  de- 
generation, provided  muscular  strength  is  no  longer  needed.  One 
does  not  speak  of  hothouse  grapes  as  degenerates.  They  doubtless 
lack  the  hardy  characteristics  of  wild  grapes,  but  these  characteristics 
are  not  needed  in  a  hothouse. 

If  it  should  prove  true  that  in  some  directions  humanitarian  im- 
pulses betray  us  into  favoring  the  survival  of  the  unfit  and  their 
perpetuation  in  the  next  generation,  such  shortsighted  kindness  must 
be  checked.  But  all  the  dangers  of  perpetuating  vital  weaknesses  can 
be  avoided  if  proper  health  ideals  are  maintained.     For  when  such 

"Physicians  maintain  thnt  some  diseases,  especially  typhoid  fever  and  pneu- 
monia, are  more  apt  to  attack  the  strong  than  the  weak. 

*  See  Prince  Kuropatkin,  "  Mutual  Aid  a  factor  in  Evolution,"  New  York 
(McClure-Phillips),  1902. 


FISHBE.]  NATIONAL   VITALITY.  723 

health  ideals  become  a  national  possession  fewer  weak  infants  will 
be  born  into  the  world.  This  will  come  about  in  three  ways:  First, 
marriage  and  "  sterilization  "  laws  will  reduce  the  number  of  mar- 
riages of  degenerates.  Secondly,  parents  will  be  more  careful  of 
transmitting  disease  or  weakness  to  their  offspring.  There  is  strong 
reason  to  believe  that  inheritance  depends  largely  upon  the  physical 
condition  of  both  parents  at  the  time  of  conception.  If  at  such  a  time 
either  parent,  or  both  parents,  are  in  a  state  of  intoxication  or  suf- 
iferers  from  venereal  disease,  this  lack  of  hygiene  on  their  part  will 
^affect  the  heredity  of  the  offspring.  Immorality,  which  practically 
[means  lack  of  sex  hygiene,  never  strengthened  a  race;  on  the  contrary 
jit  has  been  the  most  potent  cause  of  race  extinction  (of  the  Hawaiians, 
Indians,  negroes,  and  others)."  Thirdly,  the  influence  of  higher 
■ideals  of  health  and  vitality  will  tend  both  to  restore  the  attraction 
iof  a  strong  and  beautiful  physique  to  its  rightful  place  among  the 
various  attractions  which  lead  to  marriage,  and  to  lessen  the  allure- 
ments of  such  extraneous  attractions  as  wealth. 

<»  See  F.  L.  Hoffman,  "  Race  Traits  and  Tendencies  of  the  American  Negro," 
Publication  of  American  Economic  Association,  Ch.  VII.  August,  1896. 


Part  IV.— RESULTS   OF   CONSERVING   LIFE. 

Chapter  XI. — Prolongation  of  life. 

Section  1. — Life  is  lengthening. 

We  have  already  seen  evidence  of  the  possibility  of  prolonging 
life :  In  Europe  the  life  span  is  double  what  it  is  in  India.  The  death 
rate  of  Dublin  is  over  twice  that  of  Amsterdam,  and  three  times  that 
of  rural  Michigan.  Again,  making  every  allowance  for  inaccuracies  of 
old  records,  we  have  strong  reason  to  believe  that  life  is  twice  as  long 
as  three  or  four  centuries  ago,  and  modern  accurate  records  show  that 
it  is  to-day  increasing  more  rapidly  than  ever.  The  rate  at  which 
this  lengthening  proceeds  per  century  is  shown  in  the  following 
table,  based  on  Chapter  I. 

Rate  of  lengthening  life  (in  years,  per  century). 


I 


Jti 


Country. 


Periods. 


Males. 


Females.  I 


England 

Do 

France  

Prussia 

Denmark 

Sweden  

United  States: 
Massachusetts 

Do 

India 


1838-1864  to  1871-1881,  or  30  years 
1871-1881  to  1891-1900,  or  20  vears 
1817-1831  to  1898-1903,  or  76  years 
1.S67-1877  to  1891-1 900,  or  23  years 
1835-1844  to  1895-1900,  or  57  vears 
1816-1840  to  1891-1900,  or  67  years 

1789  to  1855,  or  66  years 

1855  to  1893-1897,  or  40  years 

1881  to  1901,  or  20  years 


5 

14 
10 
25 
13 
17 


III 


7 

14 
0 


S 

16 

11 

291 

15 

15 


From  this  table  we  observe :  ' 

First.  That  the  rate  of  progress  is  extremely  variable  in  different 
countries.  It  is  perhaps  no  accident  that  the  maximum  rate  obtains 
in  Prussia,  which  is  probably  the  most  progressive  country  in  the 
discovery  and  application  of  scientiiSc.  medicine.  If  progress  con- 
tinues for  a  century  at  merely  the  present  rate,  human  life  in  Prus- 
sia will  be  twenty-five  to  twenty-nine  years  longer  than  at  present. 
The  average  rate  of  improvement  for  all  the  countries,  excepting) 
India,  is  about  fifteen  years  per  century. 

Second.  It  is  noticeable  that  in  practically  all  cases  the  improve- 
ment is  more  among  females  than  males.  This  is  one  expression  of 
the  progress  which  womankind  is  now  making  in  all  lands. 

Third.  This  table,  as  well  as  the  estimate  of  Professor  Finkelnburg 
already  quoted,  shows  that  not  only  is  the  average  duration  of  human 
life  increasing,  but  that  the  rate  of  increase  is  also  increasing.  The 
estimate  of  Finkelnburg  that  the  lengthening  of  life  during  the  inter- 
val between  the  sixteenth  century  and  the  end  of  the  eighteenth  cen- 
tury was  from  eighteen  or  twenty  years  to  a  little  over  thirty  years 
shows  a  rate  of  increase  of  about  four  years  per  century.  During 
724 


:iSHEE.]  NATIONAL,  VITALITY.  725 

;he  following  century  he  estimated  that  the  life  span  increased  from 
I  little  over  thirt}^  to  thirty-eight  or  forty  years,  or  about  nine 
y^ears  per  century.  In  the  tabic  we  see  that  in  England  the  length  of 
ife  was  increasing  in  the  middle  of  the  nineteenth  century  at  a  rate 
)f  from  five  to  nine  years  per  century,  while  during  the  last  quarter 
t  was  increasing  at  from  fourteen  to  sixteen  years  per  century.  In 
\lassachusetts  the  imperfect  data  indicate  that  life  lengthened  in  the 
irst  half  of  the  eighteenth  century  at  the  rate  of  about  seven  years  a 
;entury.  The  indication  for  the  last  part  of  the  nineteenth  century 
s  that  it  increased  at  the  rate  of  fourteen  years  per  century. 
,  We  may  briefly  summarize  chronologically  the  general  rate  of 
Increase  as  follows: 

Lengthening  of  human  life  per  century. 

Years. 

)uring  seventeenth  and  eighteenth  centuries 4 

)uring  first  three  quarters  of  the  nineteenth  century 9 

'resent  rate  in  Massachusetts 14 

'resent  rate  in  Europe IT 

i'resent  rate  in  Prussia 27 

Section  2. — Table  shoicing  further  pructicable  prolongation. 

It  would  be  surprising  if  the  future  should  not  witness  a  further 
engthening  of  human  life,  and  at  an  increasing  rate.  Of  course 
here  is  a  limit  to  the  further  increase  of  human  life,  but  there  is 
jood  reason  to  believe  that  the  limit  is  still  far  off. 

The  following  table  °  shows  that  at  least  fourteen  years  could  be 
,dded  to  human  life  by  the  partial  elimination  of  preventable  diseases 
,ccording  to  the  stated  ratios  of  preventability.  This  is  equivalent 
o  a  reduction  in  the  death  rate  of  about  25  per  cent.  The  table  is 
»ased  on  the  causes  of  death  given  in  the  census  volume  for  mortality 
tatistics  for  1906.  These  causes  are  arranged  according  to  the  aver- 
ge,  or  rather  median,*  age  at  death  from  the  disease.  This  median 
,ge  is  given  in  the  second  column.    The  order  in  this  column  shows  at 

glance  the  successive  onslaught  of,  or  rather  fatality  from,  the  vari- 
us  causes  of  death.  The  table  shows  the  successive  bombardments  of 
lisease  to  which  human  life  is  subject. 

The  third  column  gives  the  average  lost  "expectation  of  life;"" 
hat  is,  the  expectation  cut  off  by  each  particular  cause  of  death. 

The  fourth  column  represents  the  percentage  which  the  deaths  from 
ach  particular  cause  bear  to  the  total  number  of  deaths  in  1900  in 
he  registration  area.  It  shows  the  relative  importance  of  the  differ- 
nt  causes  of  death  in  the  present  death  rate,  but  has  no  reference  to 
he  age  at  death. 

The  fifth  column  contains  an  estimate,  made  by  physicians,  of  the 
atio  of  preventability  of  deaths  from  each  cause  named. 

*  For  detailed  statement  in  regard  to  the  construction  of  this  table,  see  appen- 
ix  to  this  chapter. 

''By  the  "median"  age  at  death  is  meant  the  age  such  that  one-half  of  the 
eath's  occur  earlier  and  one-half  later  than  this  age.  The  "  median  "  is  a  species 
f  average,  but  differs  from  the  ordinary  arithmetical  average.  It  has  tbe  great 
dvantage  of  ease  of  computation. 

"The  "expectation"  is  taken  from  the  figures  of  Abbott  for  Massncbusotts. 
893-1897.  and  is  the  average  of  expectation  of  males  and  females.  See  Report 
itate  Board  of  Health  for  Massachusetts,  1898. 


726 


BEPORT   OF    NATIONAL  CONSERVATION   COMMISSION. 


The  items  in  the  sixth  column  are  found  by  multiplying  together 
those  in  the  fourth  and  fifth  columns,  and  express  the  percentage  whichi, 
the  preventable  deaths  from  each  cause  named  bears  to  the  total  num- 
ber of  deaths  from  all  causes. 

The  seventh  and  last  column  gives  the  figures  for  which  the  table 
is  constructed,  namely,  the  amount  of  prolongation  of  life  which 
would  come  about  through  preventing  deaths  according  to  the  ratios 
of  preventability  in  column  5.  "VVlien  it  is  said  that  a  death  is  pre- 
ventable, it  is  not,  of  course,  meant  that  the  person  saved  from  it 
will  never  die,  but  merely  that  his  death  is  postponed.  The  term 
"  postponable  "  would  avoid  a  great  deal  of  confusion  on  the  subject 

The  principle  on  which  the  last  column  is  constructed  is  simply 
the  principle  of  averages.  The  column  shows  the  prolongation  of 
life  which  would  be  caused  by  postponing  the  "  postponable  "  deaths 
by  the  amounts  indicated  in  column  3.  To  illustrate  this  princi 
pie,  suppose  ten  magnitudes  to  be  averaged  arithmetically,  and  that 
their  average  is  thirty.  To  fix  our  ideas,  we  may  suppose  these  ten 
magnitudes  to  be  represented  by  ten  lines  drawn  on  a  sheet  of  paper. 
It  is  evident  that  if  one  of  these  ten  lines  is  prolonged  the  average 
of  the  ten  will  be  thereby  increased  by  exactly  one-tenth  of  the  pro- 
longation of  that  one  line. 

Possible  prolongation  of  life.  '^ 


u 

I]' 


if 


(1) 


Cause  of  death. 


4. 

6. 

6. 

7. 

8. 

9. 
10. 
11. 
12. 
13. 
14. 

16. 
16. 
17. 
18. 
19. 
20. 
21. 

22. 
23. 
24. 
25. 


Premature  birth 

Congenital    malformation    of 

heart  (cyanosis) 

Congenital    malformations 

other  than  of  heart 

congenital  debility 

H  yd  rocephalus 

Venereal  diseases 

Diarrhea  and  enteritis 

Measles 

Acute  bronchitis 

Broncho-pneumonia 

Whoo])ing  cough 

Croup 

Meningitis , 

Diseases  of  larynx  other  than 

laryngitis , 

Laryngitis , 

Diphtheria 

Scarlet  fever , 

Diseases  of  lymphatics 

Tonsilitis 

Tetanus 

Tuberculosis    other    than    of 

lungs , 

Abscess 

Appendicitis 

Typhoid  fever 

Puerperal  convulsions 


(2) 
A. 


Median 

age  of 

deaths 

from 

causes 

named. 


Years. 
1 


1 
1 
1 
1 
1 
1 
1 
1 
1 
2 
2 

3 
3 

3 
S 

5 
8 
8 

23 

24 
24 
26 
28 


(3) 


Expecta- 
tion of 
life  at 

median 
age. 


Years. 
50 

50 

50 
50 
50 
50 
50 
50 
50 
50 
50 
54 
54 

54 
54 
64 
54 
54 
52 
52 

40 
39 
39 
38 
o37 


6(4) 


Deaths 
due  to 
cause 
named  as 
percent- 
age of  all 
deaths. 


(5) 

D. 
Ratio  of 
preventa- 
bility (post- 
ponability), 
i.  e.,  ratio  of 
'preventa- 
ble" deaths 
from  cause 
named  to 
all  deaths 
from  cause 
named. 


Per  cent. 
2 

.55 

.3 
2.3 

.1 
.3 

7.74 
.8 

1.1 

2.4 
.9 
.3 

1.6 

.07 
.06 
1.4 
.5 
.01 
.05 
.19 

.17 

.08 
.7 


(6) 
E=CD. 


Ratio  of 
preventa- 
ble" deaths 
from  cause 
named  to 
all  deaths 
from  all 
causes. 


Per  cent. 
40 


0 
40 

0 
70 
60 
40 
30 
50 
40 
75 
70 

40 
40 
70 
50 
20 
45 
80 

75 
60 
50 
85 
80 


Per  cent. 
0.8 


(7) 

F=BE. 

Years 
added  to 
average 
lifetime  If 
deathswere 
prevented 
in  the  ratio 
of  prevent- 
ability of 
column  5. 


Years.      ,, 


.92 


.21 

.11 

4.64 

2.32 

.32 

.16 

.33 

.17 

1.2 

.6 

.36 

.18 

.22 

.12 

1.12 

.6 

.03 

.02 

.98 

.25 

.002 

.02 

.15 

.13 

.05 
.35 
1.7 
.06 


.46 


.02 

.01 

.53 

.14 

.001 

.01 

.08 

.05 
.02 
.14 
.65 
.02 


•  "  Expectation  "  for  fpmal(>s. 

•  As  to  some  inaccuracies  in  this  column,  see  Appendix  to  this  chapter,  section  4. 


ISHEB.] 


NATIONAL  VITALITY. 
Possible  prolongation  of  life — Continued. 


727 


(1) 


Cause  of  death. 


Puerperal  septicemia 

Other  causes  incident  to  child- 
birtli 

Diseases  of  tubes 

Peritonitis 

Smallpox 

Tuberculosis  of  lunga 

Violence 

Malarial  fever 

Septicemia 

Epilepsy 

General,  ill  defined,  and  un- 
known causes  (including 
"heart  failure,"  "dropsy," 
and  "convulsions") 

Erysipelas 

Pneumonia  (lobar  and  un- 
qualified)   

Acute  nephritis 

Pleurisy 

Acute  yellow  atrophy  of  liver.. 

Obstruction  of  intestines 

Alcoholism 

Hemorrhage  of  lungs 

Diseases  of  thyroid  body 

Ovarian  tumor 

Uterine  tumor 

Rheumatism 

Gangrene  of  lungs 

Anemia,  leukemia 

Chronic  poisonings 

Congestion  of  lungs 

Ulcer  of  stomach 

Carbuncle 

Pericarditis 

Cancer  of  female  genital  organs 

Dysentery 

Gastri  tis 

Cholera  nostras 

Cirrhosis  of  liver 

General  paralysis  of  insane 

Hydatid  tumors  of  liver 

Endocarditis 

Locomotor  ataxia 

Diseases  of  veins 

Cancer  of  breast 

Diabetes 

Biliary  calculi 

Hernia 

Cancer  not  specified 

Tumor 

Brlght's  disease 

Embolism  and  thrombosis 

Cancer  of  intestines 

Cancer  of  stomach  and  liver.. . 

Calculi  of  urinary  tract 

Cancer  of  mouth'. 

Heart  disease 

Influenza  

Asthma  and  emphysema 

Angina  pectoris 

Apoplexy 

Cancer  of  skin 

i  Chronic  bronchitis 

\  Paralysis 


(2) 
A. 


Median 
age  of 
deaths 
from 
causes 
named. 


Years. 
28 

81 
31 
31 
32 
33 
34 
34 
84 
86 


35 
37 

37 
39 
42 
42 
43 
44 
45 
46 
46 
i& 
47 
48 
48 
48 
49 
49 
49 
52 
52 
52 
53 
53 
54 
55 
55 
56 
56 
57 
58 
58 
58 
59 
59 
59 
59 
60 
60 
61 
61 
63 
63 
64 
64 
65 
67 
70 
71 
71 


(3) 


Expecta- 
tion of 
life  at 
median 
age. 


Years. 
o37 

o35 
o35 
34 
34 
33 
32 
32 
32 
32 


SI 
30 

30 
29 

27 
27 
26 
25 
25 
24 


23 
23 
23 
23 
22 
22 
22 
20 

021 
20 
19 
19 
19 
18 
18 
17 
17 
17 

ol7 
16 
16 
16 
16 
16 
16 
15 
15 
14 
14 
13 
13 
13 
13 
12 
11 
10 
9 
S 


(4) 
C. 


Deaths 
due  to 
cause 
named  as 
percent- 
age of  all 
deaths. 


Per  cent. 
0.4 

.36 
.1 
.5 
.01 

9.9 

7.5 
.2 
.3 
.29 


9.2 
.3 


.6 
.27 
.02 
.6 
.4 
.1 
.02 
.07 
.   .1 
.5 
.03 
.4 
.05 
.4 
.2 
.03 
.1 
.6 
.5 
.65 
.09 
.9 
.3 

.002 
.8 
.17 
.04 
.4 
.8 
.17 
.27 
.9 
.08 

5.6 
.26 
.5 

1.7 
.03 
.1 

8.1 
.7 
.28 
.4 

4.4 
.2 
.8 


(6) 

D. 

Ratio  of 
preventa- 
bility(post- 
pona'bility), 
'.e.,  ratio  of 
"preventa- 
ble" deaths 
from  cause 

named  to 
all  deaths 
from  cause 

named. 


Per  cent. 
85 

50 
65 
55 
75 
75 
36 
80 
40 
0 


80 

60 

45 
80 
55 

0 
25 
85 
80 
10 

0 

60 
10 

0 
60 
70 
50 
50 
50 
10 

0 
80 
50 
50 
60 
75 
75 
25 
35 
40 

0 
10 
40 
70 

0 

0 
40 

0 

0 

0 
10 

0 
25 
50 
80 
25 
85 

0 

30 
50 


(6) 
E=CD. 


Ratio  of 
"preventa- 
ble" deaths 
from  cause 
named  to 
all  deaths 
from  all 
causes. 


Per  cent. 
0.34 

.18 
.06 
.28 
.01 
7.42 
2.7 
.16 
.12 


2.75 
.18 

8.15 

.18 
.15 


.15 
.34 
.08 
.002 


.06 
.05 


.2 
.03 
.2 
.1 

.015 
.01 


.4 

.32 

.05 

.54 

.22 

.002 

.2 

.06 

.02 


.08 
.07 
.19 


2.24 


.003 


2.02 
.35 
.07 
.1 

1.54 


.24 
.5 


(7) 
F-BE. 


Years 

added  to 

average 

lifetime  if 

deathswere 

prevented 

in  the  ratio 

of  prevent- 

abilityt)! 

column  5. 


Years. 
0.13 

.06 
.02 
.1 

.003 
2.46 
.86 
.05 
.04 


.85 
.06 

.94 
.05 
.04 


.04 
.09 

.02 
.0005 


.02 
.01 


.05 

.007 

.04 

.02 

.008 

.002 


.08 

.06 

.01 

.1 

.04 

.0003 

.03 

.01 

.003 


.01 
.01 
.03 


.36 


.0004 


.26 

.05 

.009 

.01 

.17 


.02 
.04 


•  "  Expectation  "   for  females. 


728            EEPORT   OF    NATIONAL 

CONSERVATION    COMMISSION. 

Possible  prolong 

lation  of  Z//«— Continued. 

(1) 

(2) 

(3) 

(4) 

(6) 

(6) 

(7) 

A. 

B. 

C. 

D. 

Ratio  of 
preventa- 

E=CD. 

F=BE. 
Years 

Deaths 
due  to 
cause 
named  as 
percent- 
age of  all 
deaths. 

bilitv  (post- 

Ratio  of 

added  to 

Median 

Expecta- 
tion of 
life  at 

median 

ponability), 

"preventa- 

average 

.  Cause  of  death. 

age  of 

I.e.,  ratio  of 

ble"  deaths 

lifetime  if 

deaths 

from 

causes 

"  preventa- 
ble" deaths 
from  cause 

from  cause 
named  to 
all  deaths 

deaths  wen 
prevented 
in  the  ratio 

named. 

age. 

named  to 

from  all 

of  prevent- 

all  deaths 

causes. 

abilitvof 

from  cause 

column  5. 

named. 

Years. 

Years. 

Per  cent. 

Per  cent. 

Per  cent. 

Years. 

71 

9 

0.2 

0' 

7.S 
74 
74 

9 
8 

8 

0.83 

0.2 

0.25 

10 
45 
60 

0.08 
(1.  09 
0.10 

O.OO' 
O.OO'' 

o.or 

88.  Diseases  of  bUidder 

89.  Gangrene 

90    Old  ae-e 

83 

5 

2 

0 

All  causes 

38 

100 

42.3 

a  42.  3 

14.06 

RfeSDMfe. 

Diseases  of  infancy  (having  me- 

18.5 

47 

8.8 

4.4 

Diseases  of  childhood  (having  me- 

4.2 

67 

2.8 

1.51 

Diseases  of  middle  age  ( having  me- 

dian aee  23  to  49)              

43 

49 

21.2 

6.82 

Diseases  of  late  life  (having  me- 

dian age  62  to  83) 

34.3 

28 

9.5 

1.38 

All  causes 

100                     42. 3 

42.3 

14.06 

"Althoiish    this   is    the    ratio 

of    gene 

•al    preve 

ntability 

of   deaths 

under    ex 

sting   con- 

ditions,  the  death  rate,  i.  e.,  deaths  in  relation  to  population,  will  not  in  the  end  b< 
aflected  in  tliis  ratio  but  by  only  about  l.'")  per  cent.  The  reason  for  this  paradox  is  that 
deaths  prevented  lead  to  a  larger  population   (See  appendix  to  this  chapter,  section  3). 

Similarly,  if  of  the  ten  lines  three  are  prolonged  each  a  certain 
stated  amount,  or  are  prolonged  that  amount  on  the  average,  the 
average  of  the  whole  ten  Avill  be  increased  by  three-tenths  of  this 
amount.  Consequently,  if  the  saved  lives  from  typhoid  fever  (No. 
24  in  the  table)  are,  on  an  average,  prolonged  thirty-eight  years,  and 
these  saved  lives  represent  l.T  per  cent  of  all  lives,  the  average  life  will 
be  prolonged  by  1.7  per  cent  of  thirty-eight  years.  This  is  0.65  oi 
two-thirds  of  a  year. 

All  the  calculations  are  on  the  assumption  of  expectations  of  life, 
such  that  the  saved  lives  will  die  according  to  the  present  law  oi 
mortality.  Consequently,  if  the  table  should  be  corrected  by  sub- 
stituting in  each  case  such  an  expectation  of  life  as  would  conform 
to  the  improved  mortality,  the  result  would  be  an  addition  (2.1 
years)"  to  the  estimate  of  possible  prolongation,  which  would  there- 
fore Ijecome  16.2  years.  The  resume  of  the  table  shows  that  of 
the  14  years  of  possible  prolongation  of  life  4.4  would  be  caused 
by  reducing  infant  deaths  under  or  near  1  year,  1.51  by  reducing 
mortality  from  children's  diseases,  6.82  from  reducing  the  disease- 
of  middle  life,  especially  tuberculosis  and  typhoid,  and  only  1.33 
by  reducing  the  mortality  of  diseases  the  deaths  from  which  usually 
come  after  50  years  of  age. 

•Best  estimated  graphically,  as  shown  in  appendix  to  this  chapter. 


loo  000 


So  000 


80000 


70  000 


bo  000 


50000 


4-0000 


30000 


20000 


loooo 


lO 20 30 40 50 60 70  80  90  IOoYeap 


V 

h 

==:::; 

E 

III 

I 

/ 

-./C5 

^-.. 

v\ 

\ 

^- 

^ 

1 

-■^ 

\ 

\ 

^E 

> 

^^. 

C" 

■ 

\ 

x'' 

tS" 

\ 

^- 

\t 

F^.^ 

\\ 

^^ 

\ 

^. 

\\ 

\ 

\ 

\ 

\ 

\ 

c 

\\ 

\ 

c\ 

\\ 

\\ 

\ 

\  \ 

\\ 

\\ 

\ 

\Vv 

\, 

^ 

t^ 

_  lo  20  30  40  50  60  70  So  90  IooVeAF 

0  D 


SURVIVORSHIP  CURVES,  SHOWING  SAFE  MINIMUM   IMPROVEMENT  ATTAINABLE. 


•isHRR.l  NATION  AX.  VITALITY.  729 

The  table  shows  that  seven  of  the  90  causes  of  death  are  responsible 
'or  over  half  of  the  shortening  of  life,  namely,  diarrhea  and  enteritis 
;No.  7),  broncho-pneumonia  (No.  10),  meningitis  (No.  13),  typhoid 

No.  24),  tuberculosis  of  lungs  (No.  31),  violence  (No.  32),  and 
)neumonia  (No.  38).  These  alone  shorten  life  needlessly  by  more 
ihan  eight  years.  Against  these  seven  causes,  therefore,  our  special 
efforts  should  be  directed.  Pure  milk,  pure  water,  pure  air,  and 
■easonable  protection  from  accident  are  the  chief  means  known  at 
present.  \Vlien  the  public  makes  up  its  mind  no  longer  to  endure 
mpure  milk,  impure  water,  and  impure  air,  and  unreasonable  dan- 
gers to  life  and  limb,  life  will  lengthen  eight  years,  and  probably  a 
^reat  deal  more. 

In  the  resume  of  the  table  columns  4,  6,  and  7  are  found  from  the 
)riginal  table  by  simple  addition.  Each  figure  in  the  fifth  column  is 
'ound  by  dividing  the  figure  in  the  sixth  by  that  in  the  fourth." 

The  final  figure  in  this  column,  42.3,  is  the  same  as  the  sum  of 
•olumn  6,  and  means  that  according  to  medical  opinion  42.3  per  cent 
)f  the  deaths  which  occur  under  present  conditions  are  preventable 
;postponable).  The  death  rate,  however,  will  ultimately  be  reduced, 
lot  in  this  proportion,  but  b}^  about  25  per  cent,*  while  the  average 
■luration  of  life  will  be  increased  about  33^  per  cent. 

Section  3. — Diagram  sliowing  effect  of  prolongation  at  different  ages. 

The  whole  process  is  best  seen  by  means  of  a  survivorship  table, 
I,  diagram  of  which  will  be  found  on  the  next  page. 

We  have  here  four  curves  which  represent  the  survivors  in  suc- 

essive  years  from  a  h)^pothetical  and  representative  list  of  100,000 

)ersons  born.     The  two  of  these  curves  which  should  be  noted  are 

he   inner  two,  namely,  those  labeled  "Mass.  1893-97  "  and  "  Pos- 

ible  I."     The  former  is  taken,  in  lieu  of  any  better  statistics,  as 

;e])resenting  the  existing  law  of  mortality  in  the  United  States.     The 

after  shows  what  the  law  of  mortality  would  be  if  the  ratios  of  pre- 

'entability  given  in  the  preceding  table  were  put  in  force.     The 

urve  Possible  I  is  constructed  on  the  supposition  that  all  the  deaths 

i)revented  or  postponed  subsequently^  occur  according  to  the  present 

;aw  of  mortality;  that  is,  that  expressed  in  the  curve  Mass.  1893-97. 

The  two  remaining,  or  outer,  curves  are  given  merely  for  com- 
)arison.  The  lowest,  marked  "  Mass.  1855,"  shows  the  mortality 
vhich  held  true  in  Massachusetts  in  that  year  accord hig  to  the 
stimates  of  the  actuary,  E.  B.  Elliott.''  The  difference  between  this 
urve  and  the  one  above  shows  the  number  of  years  of  life  actually 
aved  to  100,000  persons  subject  to  the  mortality  of  1893-1897  instead 
•f  the  mortality  of  1855.  The  upper  curve  (Possible  II)  shows  the 
Qodification  in  Possible  I  on  the  assumption  that  the  saved  lives, 
nstead  of  following  the  present  law  of  mortality   (Massachusetts, 

"The  result  is  in  each  case  a  weighted  average  of  the  individual  ratios  of 
reveutability  for  the  individual  causes  of  death. 

*  See   appendix. 

"See  Proceedings  of  the  American  Association  for  the  Advancement  of 
icience.  1857,  pp.  61,  69;  also  Sixteenth  Registration  Report,  Massachusetts, 
857,  p.  204. 


730  REPORT   OF    NATIONAL  CONSERVATION   COMMISSION. 

1893-1897),  follow  the  law  of  mortality  represented  in  the  curve 
Possible  II  itself." 

This  diagram  shows  at  a  glance  what  improvement  has  been  made 
in  mortality  and  at  what  ages,  and  what  improvement  is  still  pos- 
sible, and  at  what  ages,  according  to  the  preventability  known  to  be 
easily  possible.  We  see  that  the  curve.  Possible  I,  does  not  drop  as 
far  in  the  first  year  of  life  as  the  curve  Mass.  1893-97.  This  is 
because  of  the  great  saving  of  infant  lives  known  to  be  possible.  The 
years  of  life  which  would  be  saved  to  the  100,000  persons  by  the 
new  hygiene  are  represented  by  the  difference  in  area  between  the  new 
curve  AB"C"D  and  the  old  curve  AB'C'D,  from  which  it  was  con- 
structed by  applying  the  ratio  of  preventability.  This  area  can 
easily  be  measured  by  a  planimeter,  and  is  found  to  be  1,280,000. 
which,  divided  by  the  100.000  persons,  means  an  average  addition  of 
12.8  years  to  the  lifetime  of  each  person  born.  This  result  differs 
somewhat  from  the  arithmetical  calculation,  14.06,  given  in  the  pre- 
ceding table.''  If  the  upper  curve  be  used,  which  assumes  that  the 
"  saved  "  lives  die  not  according  to  the  old  but  the  new  mortality,, 
the  addition  becomes  not  12.8  but  14.9  years,  as  against  the  16.1 
computed  arithmetically.  We  may  hereafter  refer  to  this  minimum 
estimate  of  possible  increase  of  life  as,  in  round  numbers.  15  years. 
The  lengthening  of  life  would  be  from  45  to  00,  or  one-third. 

The  diagram  also  shows  the  saving  of  life  which  actually  took 
place  between  1855  and  the  period  1893-1897.  The  area  between  the 
curves  for  these  two  periods  shows  that  550,000  years  were  saved  fori 
a  supposed  group  of  100.000  persons,  or  5.5  per  person.  The  wholft 
area  of  the  new  curve  AB"C"D  is  5,810,000,  or  58.1  years  per  person, 
which  is  the  new  average  duration  of  life,  as  compared  with  45.3  for 
1893-97  and  39.8  years  for  1855.  We  may  divide  the  diagram  by 
two  vertical  lines  drawn  at  the  ages  17^  and  60  in  order  to  discover 
what  part  of  the  added  life  occurs  between  these  ages — that  is,  within 
the  working  period — and  what  parts  fall  on  either  side.  The  addi- 
tion of  12.8  years  to  the  lifetime  of  each  of  100.000  persons,  or 
1,280,000  years  of  life  in  all,  is  divided  into  three  groups,  nameh',  the 
years  falling  in  the  period  of  preparation,  200,000 ;  in  the  working 

"  The  method  of  consti-ucting  the  curves  Possible  I  and  Possible  II  from  the* 
curve  Mass.  1S93-9T  is  by  meons  of  the  ratios  of  preventability  given  in  the 
r6sum§  of  the  preceding  table.     See  appendix. 

^  The  discrepancy,  1.3  years,  is  due  to  the  fact  that  in  constructing  the  table, 
based  on  individual  diseases,  I  was  compelled  to  use  for  tlie  percentages  of  | 
deaths  by  ages  (column  4)  the  percentages  obtaining  in  the  calendar  year  lOOG: 
whereas  the  diagram  is  based  on  the  idea  of  a  stationary  population,  the  dis- 
tribution of  the  deaths  being  represented  by  the  shape  of  the  curve  Mass. 
1893-97.  The  diagramatic  method  is  therefore  more  correct.  The  abnormal 
age  distribution  in  1906  results  in  making  some  of  the  figures  in  the  last  column 
of  the  table  too  large  and  some  too  small.  In  a  general  way,  the  figures  for 
the  earlier  ages  are  too  large  and  for  the  later  ages  too  small,  although  the 
figures  which  are  most  too  large  are  probably  for  ages  30  to  35.  Consequently 
the  greatest  error  in  excess  is  for  tuberculosis,  which  is  possibly  three-fourths 
of  a  year  too  large.  No  exact  corrections  are  possible,  and  any  systematic 
corrections,  even  inexact,  would  be  very  laborious.  This  would  correspond  to 
the  elaborate  actuarial  calculations  of  Hayward  in  England  and  Glorer  in 
the  United  States.  See  Hayward  "  On  the  Construction  of  Life  Tables  and  on 
Their  Application,  etc."  Haydock  and  J.  W.  Glover,  "A  Study  of  Tuberculosis 
in  the  United  States,"  Journal  of  Michigan  State  Medical  Society,  February, 
1909. 


risiir.R.] 


NATIONAL   VITALITY. 


731 


period,  G80,000;  in  the  period  of  decline,  400,000.     The  following 
table  will  show  the  whole  process: 


tfass.  1855... 
tfass.  1893-97 
Possible  I 


Preparatory- 
period  (iiges 
0-17i). 


Years 
of  life. 


12.6 
13.5 
15.4 


Per 

cent  of 

total. 


32 
30 
26 


Working  pe- 
riod of  life 
{llh  CO). 


Years. 


21.9 
25.0 
31.8 


Per 
cent. 


55 
55 
65 


Period  of  de- 
cline (CiO  and 
beyond). 


Years. 


5.3 

6.8 

10.9 


Per 
cent. 


13 
16 
19 


Total. 


Years. 


39.8 
45.3 
58.1 


Per 
cent. 


100 
100 
100 


These  figures  show  that  in  18r)5  the  average  person  born  lived  only 
12.6  years  of  the  17^  years  in  the  period  of  preparation  for  life.  In 
1893-97  he  lived  13.5  years.  If  modern  hygiene  were  applied  accord- 
ing to  the  ratios  of  the  assigned  preventability,  the  figure  would  then 
be  15.4  years  actually  lived  out  of  the  17|.  Of  the  working  period  of 
12^  years  (17^-60,  the  average  man  living  under  the  mortality  of 
1855  had  only  about  half,  or  21.9  years;  under  the  mortality  of. 
1893-97  he  had  25.0.  and  under  the  "  Possible  I "  mortality  he  would 
have  31.8  years. 

In  percentage  the  years  in  the  working  period  remain  55  per  cent 
3f  the  total  life  in  all  cases.  This  assumes  that  with  the  prolongation 
Df  life  the  limits  of  the  working  period  remain  17^  and  60.  Since 
bhe  prolongation  of  life  carries  with  it  a  postponement  of  the  age  of 
disability,  it  follows  that  the  proportion  of  working  life  would 
actually  increase." 

It  will  be  seen  in  comparing  the  curves  on  the  diagram  that  the 
ichange  wrought  in  the  character  of  the  mortality  curve  by  the  new 
hygiene  simply  continues  the  change  already  in  progress.  The  family 
iresemblance  between  all  four  curves  is  striking. 

Section  4. — Fifteen  years  a  safe  minimum  estimate  of  prolongation  possible. 

The  estimate  of  fifteen  years  as  the  possible  prolongation  of  life 
jis  merely  a  minimum  estimate.  This  will  be  seen  from  the  following 
important  considerations: 

1.  The  estimate  takes  no  account  of  future  medical  discoveries, 
which  are  now  coming  at  such  a  rate  that  we  have  every  reason  to 
believe  they  will  soon  greatly  increase  the  ratios  of  preventability. 
Cancer,  for  instance,  has  been  put  down  with  zero  as  its  ratio  of  pre- 
ventability, but  the  scientific  world  is  intently  seeking  for  methods 
of  prevention  and  cure.  Likewise  "  old  age  "  has  been  assumed  as 
unpreventable.  Yet  Metchnikoff  maintains  with  reason  that  this 
is  a  malady  which  can  be  postponed. 

2.  The  ratio  of  preventability  of  the  above  diseases  takes  little 
account  of  the  cumulative  influence  of  hygiene.  Certain  diseases  late 
in  life  are  now  taken  to  be  unpreventable  or  only  slightly  prevent- 
able on  the  assumption  that  people  reach  those  ages  in  their  present 
degree  of  more  or  less  imperfect  health.  But  on  the  assumption  that 
personal  hygiene  had  been  practiced  since  birth,  the  vital  resistance, 
wliich  is  always  a  deterrent  of  disease,  would  have  been  strengthened. 

<•  See  Dr.  Edward  Jarvis,  "  Political  Economy  of  Health,"  Fifth  Annual  Re- 
jPort,  Mass.  Board  of  TIealtb,  1ST4,  p.  338,  ff. 

I  S.  Doc.  419,  61-2 8 


732  EEPORT   OF    NATIONAX.  CONSERVATION   COMMISSION. 

Professor  Sedgwick  tells  us  that  evidence  will  be  published  demon- 
strating "  Hazen's  theorem,"  that  every  life  saved  from  typhoid  by 
better  water  supply  means  two  or  three  persons  saved  from  deaths 
from  other  causes.  Our  table  shows  an  estimate  of  at  least  85  per  cent 
as  the  preventability  of  typhoid,  but  the  coincident  preventability  of 
other  diseases  which  this  prevention  of  typhoid  would  bring  about 
finds  no  place  in  the  table.  The  individual  estimates  given  for  these 
other  diseases  take  no  account  of  such  indirect  action.  Similarly, 
as  Metchnikoff  has  emphasized,  venereal  diseases,  though  they  sel- 
dom cause  death,  do  shorten  life,  the  "  terminal  disease  "  being  quite 
different.  The  same  is  true  of  malaria  and  hook-worm  disease,  which 
predispose  to  tuberculosis  and  other  tenninal  diseases.  But  in  the 
table  the  ratios  of  preventability  of  tuberculosis  and  other  diseases 
were  constructed  quite  irrespective  of  any  effect  from  reducing 
venereal  diseases,  malaria,  and  other  devitalizing  diseases. 

In  the  matter  of  personal  hygiene  the  cumulative  influence  is  still 
more  indirect,  and  perhaps  still  more  powerful.  It  is  now  often 
remarked  by  insurance  men  that  the  best  risks  are  not  necessarily 
the  best  physiques,  but  may  be  the  valetudinarians  who  practice  per- 
sonal hygiene. 

There  is  a  vicious  circle  of  disease  and  a  beneficent  circle  of  health 
The  so-called  "  cause  of  death  "  given  in  death  certificates  is  only  the 
terminal  cause.  It  is  often  merely  the  "  last  straw  "  of  a  terrible  load 
gradually  accumulated  through  life. 

Evidentl3^  to  exploit  the  resources  of  hygiene,  we  need  to  consider 
a  thoroughgoing  change  in  health  ideals  and  a  consequent  revolu- ! 
tion  in  the  conditions  and  habits  of  living.  What  would  then  happen 
to  human  longevity  we  can  only  conjecture.  The  possible  addition 
to  the  life  span  might,  for  aught  we  know,  be  several  times  the  fif- 
teen years  in  the  table. 

3.  The  figures  for  the  possible  prolongation  of  life  take  no  account 
of  the  ultimate  racial  effects  of  the  new  health  ideals.  If  once  a 
nation  becomes  thoroughly  alive  to  the  importance  of  maintaining 
the  stamina  of  its  citizens,  this  will,  as  we  have  seen,  affect  mar- 
riages— by  putting  a  premium  on  health  as  one  of  the  desiderata  in 
a  prospective  husband  or  wife.  The  longevity  of  succeeding  genera- 
tions would  certainlj'  be  improved — how  much,  it  would  be  useless 
to  guess. 

The  foregoing  considerations,  added  to  the  fact  that  the  estimates 
of  preventability  were  made  conservatively,  will  show  that  the  addi- 
tion of  fifteen  years  is  really  only  a  first  step.  If  clean  milk  will 
prevent  infantile  diarrheal  diseases,  if  clean  water  will  prevent 
deaths  from  typhoid  and  at  the  same  time — according  to  Hazen's 
theorem — prevent  two  or  three  times  as  many  other  deaths,  and  if 
clean  air  will  prevent  tuberculosis,  then  it  is  evident  tliat  mere 
cleanliness  in  respect  to  these  necessities  will  suffice  to  lengthen  life 
by  most  if  not  all  of  the  above  estimate.  Fifteen  years  is  merely  the 
"  ore  in  sight."  If  we  will  work  for  it,  we  may  get  an  even  richer 
prize.  ' 

Within  the  past  few  years  the  knowledge  of  the  causes  of  disease  has  become 
so  far  advanced  that  it  is  a  matter  of  practical  certainty  that  by  the  unstinted 
application  of  known  methods  of  investigation  and  consequent  controlling  action, 
all  epidemic  disease  could  be  abolished  within  a  period  so  short  as  fifty  years." 

<»E.  Ray  Lankester,  "  The  Kingdom  of  Man,"  New  York  (Holt),  1907,  p.  36, 


FiSHBE.]  NATIOlSTAli  VITALITY.  733 

Section  5. — Tfeed  of  lengthening  human  life. 

If  Metchnikoff's  noble  dream  should  be  some  day  realized,  the 
lengthening  of  human  life  would  at  once  decrease  the  burden  on  the 
productive  period.  That  period  tends  to  remain  55  per  cent  of  the 
total  years  lived,  on  the  assumption  that  the  working  period  remains 
17^  to  60,  but  the  upper  limit  tends  to  shift  forward.  In  this  way, 
both  the  absolute  and  relative  length  of  the  working  period  would 
be  increased. 

The  further  off  the  burden  of  old  age  is  shifted,  the  easier  it  is 
for  society  or  the  individual  to  accumulate  the  wealth  to  provide  for 
it.  At  present  the  burden  of  helpless  old  age  is  extremely  serious, 
as  those  countries  are  beginning  to  realize  which,  like  Denmark, 
Belgium,  Germany,  France,  and  recently  England,  have  enacted  laws 
to  provide  old-age  pensions. 

As  life  becomes  more  complex  it  requires  a  longer  period  of  prepa- 
ration. Preparation  is  education,  and  requires  time.  As  the  stock 
of  knowledge  increases,  the  period  for  acquiring  it,  or  rather  only 
enough  of  it  to  enable  one  to  earn  a  livelihood,  is  constantly  tending 
to  increase.  The  age  of  leaving  school  and  college  is  presumably 
gi'owing  greater. 

It  would  be  very  much  in  keeping  with  the  fitness  of  things  if  in 
this  century  biological  science  practically  applied  should  shift  the 
limit  of  the  further  end  of  the  working  period,  the  limit  which  we 
have  assumed  to  be  60,  to  a  later  period  of  life.  Human  life  would 
then  be  on  a  larger  scale  throughout.  It  would  provide  time  for  a 
longer  and  more  thorough  preparation  and  at  the  same  time  provide 
sufficient  years  of  working  life  to  repay  this  investment. 

As  Metchnikoff'^  well  points  out,  one  result  of  lengthening  life 
will  be  a  greater  utilization  of  accumulated  experience.  We  shall 
.have  less  immaturity  of  judgment.  The  principle  which  leads  to 
the  choice  for  members  of  the  judiciaiy  of  men  of  ripe  years  and 
knowledge  will  apply  to  every  field  of  human  activity,  even  those  fields 
which  are  now  preempted  by  young  men  because  of  the  necessity 
of  utilizing  their  vitality.  It  will  lead  to  a  sane  and  yet  a  vigorous 
conservatism.  It  will  give  to  society  a  body  of  old  yet  hale  men  of 
(experience,  whose  influence  and  worth  can  not  be  measured.  As 
Metchnikoff  has  said : 

I  Old  age,  at  present  practically  a  useless  burden  on  the  conimnnity,  will  become 
a  period  of  work  valuable  to  the  community.  As  the  old  man  will  no  longer 
be  subject  to  loss  of  memory  or  to  intellectual  weakness,  he  will  be  able  to 
apply  his  great  experience  to  the  most  complicated  and  the  most  delicate  parts 
'of  the  social  life.^ 

We  may  predict  that  when  science  occupies  the  preponderating  place  in  human 
society  that  it  ought  to  have,  and  when  knowledge  of  hygiene  is  more  advanced, 
human  life  will  become  much  longer  and  the  part  of  old  people  will  become  much 
more  important  than  it  is  to-day.'' 

Section  6. — The  normal  lifetime. 

I  What  is  the  normal  human  lifetime?  ^  Many  estimates  have  been 
made,  based  on  all  sorts  of  reasoning,  the  figures  extending  from  75 

"Prolongation  of  Life,  p.  329. 

''  Nature  of  Man,  p.  295. 

"  Metchnikoff :  "  Trolongation  of  Life,"  pp.  226-227. 

*  On  the  topic  of  human  longevitv,  see  Metchnikoff:  "The  Prolongation  of 
Life,"  Pt.  II,  Chaps.  I,  II.  Shaler :  "  The  Individual,"  New  York  (Appleton),190i, 
Chap.  III.    Lankester:  "Comparative  Longevity,"  London.  1870.  pp.  88-113. 


734  EEPORT   OF    NATIONAL  CONSERVATION   COMMISSION. 

to  200  years.  Flourens's  law,  of  doubtful  value,  that  a  mammal  lives 
five  times  the  length  of  its  growing  period,  can  not  be  applied  gener- 
ally. It  is  true,  the  horse  full  grown  at  5  may  live  25  years;  sheep 
adult  at  less  than  3  years  may  live  12;  while  elephants,  which  have  an 
unusually  tardy  development,  are  reputed  to  have  a  lifetime  of  2 
centuries. 

Haller,  a  distinguished  Swiss  physiologist  of  the  eighteenth  century,  thought 
that  man  ought  to  live  to  200  years;  Buffon  was  of  the  opinion  that  when  a 
man  did  not  die  from  some  accidont  or  disease  he  would  reach  90  or  100  years." 

In  man  the  growth  period  is  normally  continued  to  some  time  after  the 
twentieth  year;  its  exact  limit  has  not  been  ascertained,  but  from  the  statistics 
gathered  by  the  Sanitary  Commission  during  the  civil  war  it  seems  most  likely 
that  it  is  not  usually  completed  until  after  the  thirtieth  year.* 

One  method  which  has  been  suggested  to  ascertain  the  natural 
length  of  life  is  to  suppose  all  diseases  to  be  completely  eliminated 
and  those  who  now  die  of  them  to  die  of  old  age.  The  median  age 
for  death  from  old  age  is  83.  Metchnikoff,  however,  shows  the  error 
of  assuming  present  old  age  to  be  normal.  We  may  conclude  that 
the  normal  life  exceeds  83. 

There  must  needs  be,  of  course,  a  limit  to  the  possible  prolongation 
of  life.  We  find  in  recent  times  few  authenticated  cases  of  persons 
who  have  lived  for  a  hundred  years.  As  Young,  former  president  of 
the  British  Actuarial  Societv,  has  shown  in  his  interesting  book  '^  on 
centenarians,  most  cases  of  supposed  centenarians  are  either  cases  of 
conscious  or  unconscious  exaggeration  or  of  error  in  records.  For 
instance,  the  Countess  of  Desmond  is  said  to  have  lived  130  j'ears, 
owing  to  the  confusion  of  two  persons  of  the  same  name,  one  of  whom 
lived  to  be  100  years  old,  while  the  other,  her  mother,  died  at  30,  and 
their  lives  were  combined  in  subsequent  records.  There  are,  however, 
some  authenticated  cases.  Thus,  the  Norwegian  Drakenberg  was 
bom  in  1626  and  lived  until  1772.  aged  140.  "  He  was  married  when 
111  years  old,  and  as  a  widower  of  130  proposed  to  marry  again, 
although  without  success."'* 

At  Portland,  Oreg.,  ]Mrs.  ]\Iary  L.  Wood  died  recently  at  the  age 
of  120  years  and  under  circumstances  which  permitted  the  authenti- 
cation of  her  case  by  the  Oregon  Historical  Society.  From  these  and 
from  other  cases  which  might  be  mentioned,  we  may  conclude  that 
if  to-day,  notwithstanding  all  existing  chances  of  death,  it  is  possible' 
for  some  persons  to  live  beyond  120,  the  chances  in  the  future  for  a 
larger  proportion  of  such  persons  will  be  materially  improved. 
"Whether  this  proportion  could  ever  become  the  major  part  we  have 
as  yet  no  means  of  knowing.  What  is  needed  is  studj^^,  and  Metchni- 
koff is  right  in  believing  that  the  study  is  well  worth  while  from 
every  point  of  view. 

Appendix  to  Chapteb  XI. — Method  of  computing  possible  prolongation  of  life. 
Section  1. — "Expectations  "  at  mediati  ages  as  sJiort  cut  to  average  expectations. 

The  table  given  in  Chapter  XI  is  briefly  described  in  the  chapter  itself.  The' 
following  additional  explanations  are  made  in  regard  to  the  statistical  method' 
employed :  ■ 

•Metchnikoff,  "Prolongation  of  Life,"  p.  84.  ' 

*  Shaler,  loc.  cit.,  p.  61. 

«T.  E.  Young:  "Centenarians,"  London  (C.  &  E.  Layton),  1899. 

*  Ree  article  by  Harald  Westergaard,  (British)  Economic  Journal,  Vol.  IX, 
1899,  p.  315. 


FisiiEK.]  NATIONAL!  VITALITY.  735 

The  third  column,  giving  the  expectation  of  life  which  Is  lost  or  cut  off  by 
each  particular  cause  of  death,  is  estimated  roughly  by  taking  the  expectation 
of  life  pertaining  to  the  median  age  reached  by  those  who  die  from  the  cause 
named.  This  expectation  of  life  is  talien  from  the  Massachusetts  Life  Tables, 
1893-1897." 

The  method  of  using  the  median  age  is  sufficiently  exact  in  view  of  the  inexact, 
or  rather,  safe,  minimum  estimates  of  preventability  given  in  column  five.  A  per- 
fectly correct  method  would  be  much  more  laborious.  Hayward's  monograph 
on  the  effect  on  the  duration  of  life  of  eliminating  only  one  disease  (tubercu- 
losis) requires  190  pages  of  calculation.  I^he  true  method  consists  in  averaging 
arithmetically  and  weighting  these  averages  according  to  the  number  dying  at 
the  various  ages.  Specimen  computations  show  that  the  error  involved  by  the 
Bhort  cut  is  not  great. 

Thus,  for  tuberculosis  it  Is  found  that  the  average  expectation  of  life  lost 
by  consumptives  dying  in  1906  was  32  years,  whereas  the  expectation  of  life 
at  the  median  age  was  38  years.  The  former  figure  is  a  hundredfold  more  diili- 
cult  to  compute  than  the  latter.  Even  the  former  is  not  strictly  correct,  since 
It  applies  to  the  deaths  by  ages  as  distributed  in  1906,  and  not  as  distributed  in 
a  "  stationary  "  population. 

Section  2. — Basis  of  estimates  of  preventabilitv. 

The  estimates  of  preventability  given  in  column  5  need  special  explanation. 
In  a  few  cases,  these  estimates  are  based  on  statistical  experience.* 

The  groat  majority  of  them  are  based  on  clinical  experience  merely,  without 
any  exact  statistics.  They  are  thus  in  the  nature  of  expert  guesses.  The 
experts  in  ail  cases  are  pliysicians.  I  have  not  entered  any  estimate  of  my 
own,  unless  item  No.  36  might  be  so  designated.  This  item  is  the  residuum  of 
deaths  from  unljnown  causes,  or  ill-delined  causes,  and  is  made  up  to  a  large 
extent  of  cases  not  properly  reported  in  the  death  certificates.  Inasmuch  as  the 
average  preventability  for  all  other  causes  in  the  table  is  over  42  per  cent,  it 
seemed  safe  to  assign  to  deaths  from  these  unlcnown  causes  a  ratio  of  pre- 
ventability of  30  per  cent.  But  even  if  the  preventability  were  entered  as  0, 
;the  effect  in  reducing  the  result  would  be  less  than  a  year. 

Those  who  gave  to  the  construction  of  these  estimates  the  benefit  of  their 
experience,  observations,  and  reading  were  especially  asked  above  all  to  be  con- 
servative.    In  order  to  avoid  any  possibility  of  exaggeration  of  their  estimates 

«  S.  W.  Abbott,  M.  D. :  "  The  vital  statistics  of  Massachusetts  for  1897,  from 
the  thirtieth  annual  report  of  the  state  board  of  health  of  Massachusetts." 
The  expectation  is  taken  as  the  average  of  the  expectations  for  males  and 
females. 

**  In  addition  to  the  data  in  regard  to  special  diseases  discussed  in  the  text, 
Dtlier  pertinent  material  has  been  taken  into  account  by  those  who  made  the 
estimates  presented  in  the  table.  For  instance,  from  smallpox  In  London  in 
1901-2  the  mortality  was  34.6  per  cent  among  the  unvaccinated,  20.9  per  cent 
,  unong  those  vaccinated  after  the  disease  was  apparent,  and  10.3  per  cent  where 
.here  was  protective  vaccination.  In  Gloucester  In  1895-96  the  mortality  among 
;he  unvaccinated  was  40.8  per  cent  and  among  the  vaccinated  9.8  per  cent.  For 
children  under  1  year  the  unvaccinated  had  a  mortality  of  72  per  cent,  while 
;the  vaccinated  were  not  attacked.  From  cerebro-splnal  meningitis  the  average 
ioaortallty  was  70  per  cent  (Holt)  ;  the  mortality  under  serum  treatment  was  25 
per  cent  (Flexner  and  Jobling).  For  typhoid  fever,  Koch  and  his  assistants 
stamped  out  the  disease  in  Trier  by  Isolation  of  the  infected  persons  and  dis- 
infection. (Osier,  The  Practice  of  Medicine,  sixth  edition.)  This  would  prob- 
iibly  be  Impracticable  to  such  an  extent  In  a  city  on  account  of  the  great  expense 
Involved  and  the  difficulty  of  detecting  the  bacillus  carriers.  Other  figures  for 
;yphoid  fever  are  given  in  the  text.  For  diphtheria  In  New  York  City  In  1889- 
jl891  we  find  the  mortality  was  37.3  per  cent,  while  in  1902-1904  the  mortality 
isvas  10.8  per  cent.  The  board  of  health  began  to  use  antitoxin  In  1895.  These 
I  facts  were  furnished  by  Professor  Blumer.  Many  data  on  preventability  are 
given  by  John  C,  McVall  In  The  Prevention  of  Infectious  Diseases,  New  York 
i(Macmillan),  1907.  See  especially  pages  16-19.  Doctor  Stiles,  of  the  Public 
IBealth  and  Marine-Hosnital  Service,  is  soon  to  publish  figures  showing  the 
absolute  preventability  of  hook-worm  disease,  a  malady  prevalent  In  the  South, 
Dut  not  entering  into  the  census  tables.  These  tables  do  not  cover  the  Southern 
States. 


736  KEPORT   OP   NATIONAL,  CONSERVATION   COMMISSION. 

In  the  table  tholr  average  was  taken,  and  then  the  estimate,  as  entered  In  the 
table,  was  taken  either  as  that  average  or  below  it.  In  no  case  was  the  estimate 
entered  as  above  the  average  given.  When,  as  was  true  in  a  large  proportion 
of  cases,  the  different  estimates  agreed  fairly  well,  the  average  was  employed, 
or  rather  the  nearest  figure  ending  in  0,  or  5  next  below  the  average.  If  the 
individual  estimates  diverged  widelj%  an  estimate  was  used  below  the  average, 
favoring  the  conservative  estimators  rather  than  the  oi)tiinistic.  Also  in  cases 
where  only  a  few  estimates  were  obtainable,  the  estimate  aa  entered  was  put 
below  the  average  of  those  given. 

In  estimating  the  percentage  of  preventability  for  all  the  ninety  causes  of 
death,  IS  estimators  contributed.  The  number  of  estimates  of  preventability 
for  each  cause  averaged  nearly  eight  for  each  cause  of  death.  It  will  be  seen, 
therefore,  that  the  table  represents  in  a  conservative  way  medical  opinion  as  to 
the  preventability  of  disease.  The  physicians  who  contributed  these  estimates 
are:  Dr.  Joseph  M.  Flint,  professor  of  surgery,  Yale  Medical  School ;  Dr.  George 
Blumer,  professor  of  the  theory  and  practice  of  Medicine,  Yale  Medical  School; 
Dr.  H.  L.  Swain,  clinical  professor,  Yale  Medical  School;  Dr.  Oliver  T.  Osborne, 
professor  of  therapeutics,  Yale  Medical  School;  Dr.  J.  H.  Townsend,  secretary 
of  Connecticut  state  board  of  health ;  Dr.  F.  W.  Wright,  health  officer  of  New 
Haven;  Dr.  Norman  E.  Ditman,  of  Columbia  University;  Dr.  Cressy  I..  Wilbur, 
Chief  of  Division  of  Vital  Statistics,  Bureau  of  the  Census;  Dr.  L.  O.  Howard, 
Chief  of  Bureau  of  Entomology,  Department  of  Agriculture;  Dr.  William  C. 
Woodward,  chief  health  officer  of  District  of  Columbia;  Dr.  Charles  V.  Chapin, 
city  health  officer,  Providence,  R.  I.;  Dr.  Henry  B.  Baker,  ex-secretary  Michigan 
state  board  of  health,  ex-president  American  Public  Health  Association ;  Dr. 
J.  H.  Kellogg,  superintendent  of  the  Battle  Creek  Sanitarium ;  Dr.  Charles  H. 
Castle,  of  Cincinnati,  Ohio;  Dr.  Harry  M.  Steele,  of  New  Haven,  Conn.; 
Dr.  L.  Emmett  Holt,  of  New  York ;  Dr.  Edwin  O.  .Tordan,  of  the  Memorial  Insti- 
tute for  Infectious  Diseases,  Chicago,  111.;  Dr.  Prince  A.  Morrow,  president  ot 
the  American  Society  for  Sanitary  and  Moral  Prophylaxis. 

Section  3. — Meaning  of  "  preventable." 

The  meaning  of  the  word  "  preventable"  requires  some  explanation. 

1.  It  is  to  be  noted  that  column  5  gives  the  ratio  of  preventability  for  mor- 
tality and  not  for  morbidity.  It  means  ratio  of  preventable  deaths  to  all  deaths, 
not  to  all  cases  of  illness. 

2.  Since  the  word  "  preventable  "  implies  the  hypothesis  of  different  conditions 
from  those  which  actually  exist,  it  is  necessary  to  specify  what  hypothetical 
conditions  shall  be  implied  in  the  term.  Doubtless  tuberculosis  would  be  over 
99  per  cent  preventable  if  we  should  conceive  as  our  hypothetical  conditions  that 
every  individual  could  live  on  the  prairies  of  the  West,  out  of  doors,  be  provided 
with  the  best  of  food,  most  congenial  of  tasks,  and  free  from  overwork  and 
worry.  Needless  to  say,  the  figures  in  the  table  do  not  imply  such  Utopian  con- 
ditions, nor  do  they  imply  new  medical  discoveries.  One  hundred  per  cent  oi 
evei-y  disease  might  be  preventable  if  we  conceived  as  our  hypothesis  that  the 
means  of  prevention  are  known  and  applied.  The  hypothetical  condition 
selected  for  the  meaning  of  the  term  "  preventable  "  is  contained  in  the  following 
definition:  A  "ratio  of  preventahility ''  is  the  fraction  of  all  deaths  lohicJi 
tcoald  be  avoided  if  knowledge  now  existing  among  ivell-informed  men  in  the 
medical  profession  were  actually  applied  in  a  reasonable  tcay  and  to  a  reason^ 
able  extent.  The  term  "  reasonable  "  is  of  course  elastic,  and  will  be  somewhat 
differently  interpreted  by  different  persons,  biit,  as  in  law,  where  "  reasonable 
care  "  is  often  used  as  a  proviso,  it  is  impossible  to  make  any  more  specific 
condition. 

3.  Considerable  confusion  exists  in  the  minds  of  many  people  in  regard  to  tW 
number  of  deaths  which  might  be  prevented,  or,  as  it  is  popularly  expressed, 
the  number  of  lives  which  might  be  saved.  Since  death  is  ultimately  inevitable 
for  all,  no  life  can  be  saved  except  temporarily.  It  will  serve  to  avoid  confusion 
if  "  preventable "  is  explained  as  "  postponable."  The  question  arises  when 
deaths  are  postponed.  How  long  are  they  postponed?  The  answer  is.  They  an 
supposed  to  occur  according  to  existing  rates  of  mortality.  Thus,  those  saved 
from  croup  (No.  12)  at  age  2  will  later  die  as  do  others  who  are  living  at  age  2, 
and  will  therefore  have  the  expectation  of  life  (54  years)  pertaining  to  that  age. 

4.  The  above  explanation  will  serve  to  meet  an  objection  which  otherwise 
would  immediately  occur  to  the  reader.  If  diseases  of  early  life  are  prevented] 
the  result  will  necessarily  be  an  increase  of  the  diseases  in  later  life.  Foj 
instance,  if  all  the  causes  of  death  could  be  abolished  except  old  age,  there 


KisHEtt.]  NATIONAL  VITALITY.  737 

would  be  a  great  increase  in  the  number  of  deaths  from  old  age,  which,  instead 
of  constituting  the  2  per  cent  of  all  deaths,  which  it  does  at  present,  would  con- 
stitute 100  per  cent. 

But  the  fact  that  all  lives  saved  will  add  to  the  later  mortality  is  fully,  and 
more  than  fully,  taken  into  account  in  our  calculations.  When  we  nssume  that 
certain  lives  now  lost  at  a  given  age  might  be  saved,  we  also  assume  that  they 
would  not  be  saved  again  (even  from  the  same  disease),  but  would  die  off 
according  to  the  old  rates  of  mortality  at  successive  ages.  Their  new  lease  of 
life  would  simply  be  the  old  expectation  of  life.  As  a  matter  of  fact,  lives  now 
lost  could  probably  be  saved,  not  only  once,  but  several  times. 

AVe  may  here  explain  the  paradox  mentioned  in  the  text — namely,  that  a 
proventability  of  42.3  per  cent  of  deaths  under  present  conditions  does  not  imply 
tli:it  the  death  rate  would  ultimately  be  reduced  42.3  per  cent. 

The  death  rate  would  ultimately  depend  on  conditions  of  the  distribution 
of  ages  and  diseases  entirely  different  from  those  now  prevailing.  This  will 
be  clear  if  we  think  what  would  happen  if  the  proventability  expressed  in  the 
tnl)le  could  be  immediately  applied.  During  the  ensuing  year  it  would  be  found 
that  about  42  per  cent  of  present  deaths  would  not  occur.  A  consequence  of 
this,  however,  would  be  that  the  persons  whose  lives  were  prolonged  would  die 
at  a  later  period,  since  no  death  is  absolutely  prevented,  but  only  postponed. 
Kxcn  if  100  per  cent  of  all  deaths  were  prevented  (postponed),  but  the  post- 
pi  mement  were  fo4-  a  very  short  time,  the  effect  in  reducing  the  death  rate 
would  be  extremely  small.  On  the  other  hand,  if  only  1  per  cent  of  the  prevent- 
able deaths  were  postponed  for  a  sufhciently  long  time,  the  ultimate  effect  would 
be  to  reduce  the  death  rate  much  more  than  1  per  cent.  After  the  deaths 
which  had  been  i)Ostponed  had  reentered,  a  new  equilibrium  would  be  estab- 
lished. Under  these  new  conditions  the  ratio  of  the  deaths  to  the  population 
would  not  be  42.3  per  cent  lower  than  at  present,  but  only  about  25  per  cent. 
At  present  the  average  duration  of  life,  taken  from  the  Massachusetts  table 
for  1893-1897,  is  about  45  years.  The  ratio  of  proventability  in  the  above  table 
would  increase  this  life  by  about  fifteen  years,  making  it  60  years.  The  ratio 
of  45  to  GO,  showing  the  increase  in  the  life  span,  will  be  the  inverse  of  the 
ratio  00  to  45  in  a  "  stationary  "  population,  which  would  show  the  resulting 
reduction  in  the  death  rate.  This  is  a  reduction  of  25  per  cent.  Thus  the  pre- 
.ventability  of  42.3  per  cent  of  deaths  under  present  conditions  and  in  the  man- 
ner indicated  in  the  table  involves  a  lengthening  of  life  of  33J  per  cent  and  a 
reduction  of  the  death  rate,  after  readjustment  of  deaths  by  ages,  of  about  25 
per  cent. 

Section  4. — Error  from  abnormal  age  distribution  of  deaths  in  1906. 

The  table  as  given  is  constructed  for  deaths  occurring  in  the  calendar  year 
[1906.  Its  interpretation,  however,  is  to  be  made  on  the  basis  of  a  survivorship 
table.  In  a  stationary  population  the  age  distribution  of  deaths  in  any  year 
,would  be  the  same  as  in  a  survivorship  table;  but  since  the  United  States  has 
not  a  stationary  population,  this  identity  holds  only  approximately. 
,  The  discrepancy  accounts  for  the  difference  of  one  and  three-tenths  years  in 
'the  prolongation  of  life,  as  calculated  in  the  table  and  by  means  of  the  dia- 
gram. The  latter  is  the  more  correct,  as  it  is  based  on  a  survivorship  table, 
,or — what  amounts  to  the  same  thing — on  such  mortality  as  would  exist  in  a 
stationary  poputation.  The  only  way  in  which  this  diagram  can  be  vitiated 
by  the  slightly  abnormal  age  distribution  of  deaths  in  the  year  1906  is  as  this 
abnormal  distribution  affects  the  average  ratios  of  proventability  used  in  con- 
structing the  diagram.  These  ratios  are  based  on  column  (5)  of  the  resumg 
of  the  table.  The  four  figures  from  the  table  are  adjusted  by  graphic  interpola- 
tion in  the  usual  way,  so  as  to  form  a  continuously  varying  series  of  figures  for 
successive  years  of  life.  These  ratios  are  in  each  case  an  average  of  the  indi- 
vidual ratios  for  particular  diseases,  contained  in  the  same  column  (5)  of  the 
larger  table.  The  "  weights  "  are  slightly  vitiated  by  the  fact  that  the  age  dis- 
tribution of  deaths  in  1906  is  not  the  normal  distribution  of  a  stationary  popula- 
tion. It  is  only  as  the  "  weighting  "  is  thus  affected  that  the  diagram  can  be 
vitiated  through  our  being  forced  to  use  the  figures  for  1906  instead  of  those 
for  an  ideal  stationary  population,  since  such  figures  are  unobtainable.  The 
.error  from  this  source  is  infinitesimal,  and  we  may  depend  on  the  results  of  the 
diagram,  12.8  to  14.9  years,  as  practically  free  from  any  appreciable  error  due 
to  the  use  of  short-cut  methods. 


738  RI':i'ORT  OF    NATIONAL    CONSERVATION    COMMISSION. 

Section  5. — Ratios  of  preventahility  hy  ages  derived  from  ratios   by  diseases. 

In  regard  to  the  r6sum6  containing  the  average  ratios  of  preventability  hold 
Ing  true  during  different  ages,  it  will  be  observed  that  they  are  obtained  indl 
rectly,  by  calculating  from  the  individual  ratios  of  preventability  for  difleren 
dif^'ases  given  In  the  table  itself.  Although  these  diseases  are  not  absolutelj 
limited  to  the  times  within  which  their  median  falls,  there  is  a  fairly  distinc 
line  of  demarcation  between  the  groups,  especially  between  children's  diseases 
and  those  of  middle  life.  The  table  shows  no  disease  with  a  median  age  o: 
Incidence  between  8  and  23  years,  and  tlie  census  table  of  deaths  for  1906  shows 
that  a  very  small  percentage  of  the  total  deaths  occur  between  ages  10  and  20 
Even  if  the  diseases  considered  for  the  four  epochs  of  life  given  in  the  resumi 
did  extend  somewhat  into  the  regions  of  the  adjacent  epochs,  the  effect  wouU 
not  change  the  result  appreciably  and  would  be  as  likely  to  change  It  in  on* 
direction  as  the  other.  The  reason  is  that  the  items  of  the  column  in  th« 
resume  for  "  ratio  of  preventability  "  are  obtained  by  dividing  the  figures  ii 
column  6  by  those  in  column  4,  each  of  these  two  being  found  by  adding  th« 
individual  figures  in  the  table  for  each  age  group  concerned.  The  extensioi 
of  diseases  of  an  age  group  outside  of  that  group  will  apply  equally  to  botl 
terms  of  the  ratio,  those  in  the  fourth  and  sixth  columns,  and  will  not  substan 
tially  afCect  the  quotient  in  the  fifth  column. 

Section  6. — Alloicance  for  toeakness  of  prolonged  lives. 

The  use  In  column  2  of  the  expectations  of  life  derived  from  the  Massachu 
setts  1893-1897  life  table  is  equivalent  to  the  assumption  that  If  preventable 
deaths  were  prevented  the  lives  thus  saved  would  proceed  to  die  off  according 
to  the  mortality  of  Massachusetts,  1893-1897.  This  assumes  that  since  ISgS-lSQ'i 
there  has  been  no  improvement  in  the  expectation  of  life,  and  that  the  savec 
lives  will  not  share  in  the  improvement  which  the  table  itself  shows  forth.  Th« 
reason  that  a  later  life  table  than  for  1893-1897  was  not  used  is  that  no  latei 
life  table  is  available.  If  it  were,  it  would  show  larger  figures  in  column  2 
and  consequently  a  larger  total  result  for  the  possible  prolongation  of  life  thar 
fourteen  years. 

The  reason  the  "  expectation  "  in  column  3  does  not  take  account  of  the  effect 
of  the  improvement  in  mortality  resulting  from  the  table  is  that  this  improve- 
ment can  not  be  calculated  until  column  3  is  filled,  and  we  prefer  to  use  as  a  firsl 
approximation  a  conservative  figure  in  column  3,  rather  than  to  guess  at  mor€ 
likely  figures.  The  conservative  assumption  used  seems  also  advisable,  because 
of  the  fact  that  in  the  42.3  per  cent  of  persons  in  the  life  table  who  would  bf 
saved  from  death  and  given  a  new  lease  of  life  there  would  be  suffered  a  greater 
mortality  than  that  of  the  average  persons  that  now  pass  that  age  in  safety, 
for — on  the  principle  of  the  survival  of  the  fittest — it  is  intrinsically  probabk 
that  those  who  now  die  at  any  age  are  weaker  than  those  who  do  not. 

How  much  allowance  should  be  made  for  this  factor  of  differential  mortality 
it  is  impossible  to  say  with  certainty.  But  in  another  paper  "■  I  have  dealt  with 
the  same  question  applied  to  tuberculosis.  Taking  the  figures  of  Dr.  LawrasoD 
Brown,  giving  the  mortality  experience  among  the  apparently  cured  cases  ol 
tuberculosis  discharged  from  the  Adirondack  Cottage  Sanitarium,  and  making 
certain  allowances,  it  seems  that  if  tuberculosis  were  prevented  its  present  vic- 
tims would  have  more  than  three-fourths  of  the  expectation  of  life  belonging  to 
others.  Let  us  assume  that  this  ratio  is  equally  conservative  as  applied  to  all 
other  cases  of  prolongable  life.  Now,  it  so  happens  that  the  expectation  of  life 
at  birth  in  the  Massachusetts  life  table  of  1893-1897  is  almost  exactly  three- 
fourths  of  the  expectation  which  our  table  and  diagram  shows  would  be  possible 
if  prevention  were  properly  practiced.  This  would  give  45  years  as  the  expecta- 
tion of  life  at  birth  for  the  saved  lives,  01  for  other  lives,  and  59  for  all  lives. 
Surely  this  seems  sufficient  allowance  for  the  existence  of  any  possible  inferior- 
ity among  the  lives  which  would  be  saved. 

Section  7. — Diagram  "Possible  I,"  making  this  alloicance,  compared  with  "Possible  II," 

omitting  it. 

If  no  allowance  for  inferiority  among  saved  lives  were  necessary,  the  results' 
of  the  calculation  given  in  the  table  would  be  only  a  first  approximation  and 

«  "The  cost  of  tuberculosis  in  the  United  States  and  its  reduction,"  read  before 
the  International  Congress  on  Tuberculosis,  1908. 


nsuEB.l  NATIONAI.  VITALJTT.  739 

would  need  to  be  followed  by  successive  and  closer  approximations.    We  can  get 
much  quicker  results  by  means  of  the  diagram  and  a  planimoter. 

If  we  apply  the  ratios  of  preventability  for  these  four  groujis,  we  are  able  to 
construct  the  new  survivorship  table  on  the  basis  of  Mr.  Abbott's  for  18D:'.-1S97. 
AH  that  is  necessary  is  to  begin  the  new  survivorship  table  at  the  same  point 
that  the  old  begins,  and  continue  from  that  point  and  every  other  point  lli rough- 
out  Its  course  by  the  following  procedure :  Through  the  point  draw  a  Hue  down- 
ward and  to  the  right  for  one  year,  at  the  same  percentage  slope  as  Abbott's 
table  shows  for  that  year.  This  line  indicates  what  survivors  there  would  be  if 
their  mortality  were  not  affected  at  all  by  the  ratio  of  preventability.  The 
deaths  during  that  year  would  be  represented  by  the  drop  of  the  curve  within 
the  year.  Next,  taking  the  proper  fraction  of  this  drop,  as  indicated  by  the 
ratio  of  preventability,  we  pass  vertically  upward  this  amount  from  the  end  of 
the  line,  and  from  the  new  point  so  obtained  proceed  in  like  manner  for  each 
subsequent  year.  The  result  is  a  series  of  teeth  the  upper  points  of  which  are 
points  on  the  required  curve.  Joining  these  points,  we  obtain  the  curve.  This 
process  explains  the  theory.  This  gives  the  table  called  "  Possible  I,"  and  takes 
full  account  of  the  fact  that  the  ratios  of  preventability  continue  to  apply  to 
saved  life  as  much  as  to  other  life.  The  table  "  Possible  I  "  represents  the  sur- 
vivorship table,  under  the  assumption  that  the  lives  saved  once  are  given  no 
further  advantages,  but  follow  thereafter  the  old  law  of  mortality,  that  for 
1S93-1S97. 

Section  8. — Reciprocal  relation  between  longevity  and  mortality  shown  by  diagram. 

We  may  take  this  opportunity  to  explain,  for  the  benefit  of  the  general  reader, 
the  reciprocal  relations  existing  between  the  death  rate  in  a  stationary  popula- 
tion and  the  average  duration  of  life.  Consider  the  diagram  "  Massachusetts, 
1S!)3-1S97."  It  shows  the  life  history  of  100,000  persons  born.  Let  us  suppose 
a  community  unaffected  by  emigration  or  immigration,  and  in  which  there  are 
100,000  births  each  year.  Let  us  suppose,  further,  that  the  100,000  persons  born 
each  year  die  afterwards  according  to  the  law  of  mortality  represented  by  the 
curve  "  Massachusetts,  1S93-1S97."  Evidently  in  such  a  community  there  will 
not  only  be  100,000  births,  but  there  will  be  100.000  deaths  each  year,  and  the 
population  will  be  stationary.  It  will  also  be  true  that  the  same  diagram  can 
be  taken  to  represent  the  age  distribution  of  this  stationary  population.  Thus, 
those  living  at  age  10  will  be  the  survivors  of  the  100,000  born  ten  years  ago, 
"  and  the  number  of  such  survivors  is  the  ordinate  of  the  curve  at  10  years. 
Thus,  every  ordinate  of  the  curve  represents  not  only  the  survivors  to  a  certain 
age  out  of  100,000  births,  but  also  represents  the  number  In  the  population  at 
that  age.  The  area  of  the  curve  therefore  represents  total  population  (when 
regarded  as  made  up  of  vertical  sections).  It  likewise  represents  the  total 
number  of  years  lived  by  100,000  persons  (when  regarded  as  made  up  of  hori- 
zontal sections).  Now,  the  death  rate  is  the  ratio  of  deaths  to  population — i,  e., 
t!ie  ratio  of  100,000  to  the  area  of  the  curve.  The  average  duration  of  life  is 
the  total  years  lived  by  100,000  persons  divided  by  100,000 — that  is,  it  is  the 
area  of  the  curve  divided  by  100,000.    These  are  clearly  reciprocals. 

Chapter  XII. — The  money  value  of  increased  vitality. 
Section  1. — Money  appraisal  of  preventable  wastes. 

Estimates  of  the  money  value  of  preventable  wastes  depend  on  the 
valuation  of  human  life,  of  which  several  appraisals  have  been 
attempted. 

Prof,  J.  S.  Nicholson  estimated  that  in  Great  Britain  human  labor 
capitalized  was  worth  five  times  all  other  capital." 

Engel  computed  that  each  child  costs  100  marks  at  birth,  110  marks 
the  first  year,  120  the  second,  and  so  on.  At  20  he  will  have  cost 
2,310  marks,  or  $560.  But  one-half  die  before  20.  Hence  each  per- 
son who  reaches  the  age  of  20  actually  costs  society  much  more  than 
$5G0;  possibly  as  high  as  $1,000,  if  Engel's  estimates  are  correct. 
Professor  Mayo-Smith  estimated  that  men  and  women  between  the 

"  See  "  The  Living  Capital  of  the  United  Kingdom,"  (British)  Economic 
Journal,  1891. 


740 


REPORT   OF    NATIONAL.  CONSERVATION    COMMISSION. 


ages  of  15  and  45  averaged  $1,000  in  value.*  As  to  the  value  of  immi- 
grants to  this  country,  he  says:  "Every  immigrant  must  represent 
labor  value  with  at  least  the  value  of  a  slave.  It  is  figured  that  each 
innnigrant  is  worth  $875."  * 

The  best  method  of  estimating  the  economic  value  of  life  and  ita 
increased  duration  is  by  the  capitalization  of  earning  power.  Dr. 
William  Farr,  of  England,  has  estimated  that  a  baby  born  to  an 
English  agricultural  laborer  is  worth  in  capitalized  earning  power 
about  £5,  or  $25.  This  is  the  discounted  value  of  its  future  earnings 
estimated  on  its  probable  life  loss  the  discounted  value  of  the  cost 
of  rearing  it  during  the  period  of  dependence  and  of  maintaining 
it  when  helpless  through  old  age.  In  the  same  way  he  estimates  the 
value  of  a  life  at  other  ages — 10  years,  20  years,  50  years,  etc.*' 

In  lieu  of  any  estimates  for  the  United  States  we  may  take  Farr's 
figures  for  agricultural  laborers  as  representing,  roughly,  the  rela- 
tive worth  of  a  man  or  woman  in  the  United  States.  To  obtain  the 
absolute  figures,  therefore,  we  need  simply  to  multiply  these  of  Farr 
by  a  constant  factor  representing  the  ratio  between  the  average  earn- 
ings in  the  United  States  and  the  earnings  which  Farr  uses  as  the 
yearly  income  of  an  agricultural  laborer. 

AVe  take,  in  the  absence  of  any  good  statistics,  $700  per  annum  as 
a  guess,  but  a  safe  minimum'*  for  the  average  earnings  of  workers  of 
all  grades,  from  day  laborers  to  railroad  presidents.  This  assumes 
that  all  of  the  working  years  are  actually  employed  in  work.  But 
since  about  one- fourth  of  the  persons  of  working  age  are  not  workers, 
but  are  supported  (for  the  most  part)  by  earnings  of  capital,  the 
average  should  be  cut  down  to  three-fourths  of  this  figure,  or  $525. 

Substituting  this  figure  for  the  £31  in  Farr's  table,  we  can  recon- 
struct it  to  represent  the  minimum  worth  of  the  average  American 
life  at  different  ages.  The  following  figures  are  taken  from  the 
table  thus  computed : 


Age. 

Net 

worth  of  a 

person,  in 

dollars. 

Age. 

Net 

worth  of  a 

person,  in 

dollars. 

0 

90 

30 

4,100 

5                                       

950 
2, 000 

50 

2,900 

10            

SO 

-700 

20  

4,000 

i 

From  the  table  from  which  these  figures  are  taken  it  is  possible  to 
base  minimum  estimates  for  (1)  the  average  economic  value  of  the 
inhabitants  of  the  United  States  by  using  the  census  figures  for  age 


"  Mayo-Smith,  Statistics  and  Sociology,  p.  177. 

^  Mayo-Smith,  Emigration  and  Immigration. 

c  See  Farr,  "  Vital  Statistics,"  p.  536. 

^  See  Fisher  "  Cost  of  tuberculosis,"  read  before  the  International  Congress 
on  Tuberculosis,  Washington,  1908.  This  is  the  estimated  minimum  used  in 
my  paper  on  the  "  Cost  of  tuberculosis."  The  calculntions  are  based  on  $1  a 
day  as  the  ordinary  minimum  enrnings  of  unskilled  labor,  and  assume  a  dis- 
tribution of  a  number  of  earnei-s  of  high  amounts  according  to  the  scale  of 
distribution  which  Professor  Pareto  finds  fairly  uniform  in  form,  although  not 
In  amount  in  various  countries.  The  late  Honorable  Carroll  D.  Wright,  whose 
opinion  was  worth  more,  prohnlily.  than  that  of  any  other  man  in  the  United 
Stales,  stated  that  he  would  not  regard  $1,OUO  as  excessive.  The  figure  is 
intended  to  include  the  earnings  of  women  (including  housewives  as  earners). 


usiiEo.]  NATIONAL.  VITALITY.  741 

distribution  of  population;  this  calculated  average  is  $2,900;  (2)  the 
average  economic  value  of  the  lives  now  sacrificed  Iby  jireventable 
deaths,  using  the  age  distribution  of  deaths,  and  the  percentages  of 
pieventability;  this  calculated  average  is  $1,700. 

The  first  figure  shows  that  what  might  be  called  the  vital  assets  of 
the  United  States  for  the  population  of  over  85,500,000,  as  estimated 
by  the  census  of  1907,  amount  in  value  to  85,500,000X$2,900,  or 
$250,000,000,000,  which,  though  a  minimum  estimate,  greatly  ex- 
ceeds the  value  of  all  other  wealth ;  "  the  second  figure  enables  us  to 
estimate  the  needless  waste  of  our  vital  assets. 

If  we  take  the  estimate  of  Professor  Willcox  of  the  death  rate  in 
the  United  States,  as  at  least  18  per  1,000  for  the  85,500,000  persons 
estimated  by  the  census  as  the  population  of  the  United  States  in 
1907,  we  have  1,500,000  as  the  number  of  deaths  in  the  United  States 
per  annum.  Of  these  1,500.000  deaths,  42  per  cent,  or  630,000,  are 
annually  preventable  or  postponable.  Since  each  postponement 
would  save  on  the  average  $1,700,  the  national  annual  unnecessary 
loss  of  capitalized  net  earnings  is  630,000X$1,700,  or  $1,070,000,000, 
or  about  $1,000,000,000. 

"We  saw  in  Chapter  III  that,  with  our  present  population,  there 
are  always  about  3,000,000  persons  in  the  United  States  on  the  sick 
list.  For  the  most  part  these  persons  are  older  than  the  average. 
Farr  gives  a  table  *  showing  that  morbidity  increases  with  age  in 
geometric  progression.  By  means  of  his  table  we  may  calculate  on 
the  same  basis  as  the  previous  calculations — that  of  the  3,000,000 
sick,  very  close  to  a  third,  or  1,000,000  persons,  are  in  the  working 
period  of  life.  Assuming  that  average  earnings  in  the  working 
period  are  $700,  and  that  only  three-fourths  of  the  one  million  poten- 
tial workers  would  be  occupied,  we  find  over  $500,000,000  as  the  mini- 
mum loss  of  earnings. 

The  cost  of  medical  attendance,  medicine,  nursing,  etc.,  is  con- 
jectured by  Doctor  Biggs  in  New  York  to  average  for  the  con- 
sumptive poor  at  least  $1.50  per  daj^  of  illness.  The  cost  per  day  of 
other  illnesses  than  tuberculosis  is  presumably  greater,  and  also  the 
cost  per  day  for  other  classes  is  higher  than  for  the  poor.  Applying 
this  to  the  3,000,000  years  of  illness  annually  experienced,  we  should 
have  $1,500,000,000  in  all  as  the  minimum  annual  cost  of  this  kind. 

The  statistics  of  the  Commissioner  of  Labor  '^  show  that  the  average 
expenditure  for  illness  and  death  amount  to  $27  per  annum.  This 
is  for  workingmen's  families  only.  But  even  this  figure,  if  applied 
to  the  17,000,000  families  of  the  United  States,  would  make  the  total 
bill  for  caring  for  illness  and  death  $460,000,000.  The  true  cost  may 
well  be  more  than  twice  this  sum.  Certainly  this  estimate  is  more 
than  safe  and  is  only  one-third  of  the  sum  obtained  by  using  Doctor 
Biggs's  estimate. 

The  sum  of  the  costs  of  illness,  including  loss  of  wages  and  cost  of 
care,  is  thus  $460,000,000-f$500,000.000,  or  $960,000,000. 

The  above  estimate  is  a  general  one  for  all  illness.  It  would  be 
possible  to  offer  figures  for  the  particular  losses  from  particular  dis- 

"  Mr,  Le  Grand  Powers,  of  the  Bureau  of  the  Census,  Washington,  estimates 
that  the  total  wealth  in  America  (exclusive  of  human  beings)  amounts  to 
§107,000,000,000. 

''Vital  Statistics,  p.  510. 

«  Eigbicontli  Annual  Report,  1903,  p,  509. 


742  REPORT    OF    NATIONAL  CONSERVATION   COMMISSION. 

eases.  Thus,  from  tuberculosis,  the  gross  loss  of  earnings  by  illness 
and  of  potential  earnings  cut  off  by  death,  together  with  the  expenses 
of  illness,  etc.,  amount  to  over  $1,000,000,000  per  annum." 

Of  the  sum  mentioned,  the  loss  to  the  consumptives  themselves 
amounts  to  over  $660,000,000,  leaving  $440,000,000  as  the  loss  to  other 
members  of  the  community.  At  least  three- fourths  of  these  costs 
are  preventable.  Dr.  George  M.  Kober  thinks  it  is  conservative  to  say 
that  the  annual  cost  of  typhoid  in  the  United  States  is  $350,000,000* 
and  Dr.  L.  O.  Howard  believes  that  malaria  alone  costs  the  country 
$100,000,000  annually,  and  the  insect  diseases  generally  $200,000,000.0 
Pie  points  out  that  one  great  item  of  loss  is  the  reduced  value  of  real 
estate  in  malarial  regions.  By  drainage  and  destruction  of  mos- 
quitoes most  of  this  waste  could  be  saved.  The  cost  of  the  care  of  the 
insane  and  feeble-minded  is  estimated  by  Charles  L.  Dana  at  $85,- 
000,000  annually.**  What  fraction  of  these  costs  is  preventable  it  is 
difficult  to  say.  The  economic  loss  due  to  alcohol  has  been  variously . 
estimated.*  Of  the  billion  dollars  or  more  found  to  represent  the  cost . 
of  illness,  by  far  the  major  part  is  certainly  avoidable.  This  is  the 
belief  of  the  best  observers,  such  as  Doctor  Gulick,  Doctor  Kellogg, 
Mrs.  Richards,  Doctor  Anderson,  and  others.  Unfortunately  there 
are  no  exact  statistics  of  preventability.  We  feel  safe,  however,  in 
concluding  that  at  least  half  a  billion  could  be  saved  from  the  pres- 
ent cost  of  illness.  This,  added  to  the  loss  by  preventable  deaths 
of  potential  earnings  of  a  billion,  gives  at  least  a  billion  and  a  half 
of  preventable  waste.  This  does  not  include  the  losses  from  inef- 
ficient work  due  to  drunkenness  or  other  vicious  habits;  nor  does 
it  include  the  cost  of  "  undue  fatigue,"  which  we  have  some  reason 
to  believe  exceeds  in  its  effect  on  efficiency  the  loss  from  illness.  But 
it  would  not  be  possible  to  state  this  loss  in  any  definite  or  convincing 
figures. 

The  actual  economic  saving  annually  possible  in  this  country  by 
preventing  needless  deaths,  needless  illness  (serious  and  minor),  and 
needless  fatigue,  is  certainly  far  greater  than  one  and  a  half  billions, 
and  may  be  three  or  more  times  as  great. 

Dr.  George  M.  Gould  estimated  that  sickness  and  death  in  the 
United  States  cost  $3,000,000,000  annually,  of  which  at  least  a  third 
is  regarded  as  preventable.^ 

The  trouble  is  the  public  does  not  believe  in  this  waste  from  being  "  just 
poorly,"  and  "  so  as  to  be  about."  It  has  no  conception  of  the  difference 
between  working  with  a  clear  brain  and  steady  hand  and  with  a  dull  and 
nerveless  tool.     They  must  be  convinced  somehow.* 

°  See  Irving  Fisher :  "  Cost  of  Tuberculosis  in  the  United  States,  aiad  its 
Retluction." 

''See  his  "Conservation  of  life  and  health  by  improved  water  supply,"  read 
before  the  White  House  Conference  of  Governors,  190S. 

"  Keport  to  Conservation  Commission  on  "  Economic  loss  to  the  people  of  the 
United  States  through  insects  that  carry  disease." 

<*  See  "  Psychiatry  in  its  relation  to  other  sciences,"  by  Charles  L.  Dana,  before 
the  section  on  psychiatry  at  the  International  Congress  of  Arts  and  Sciences, 
St.   Louis,   September,  1904. 

«  "  Economic  aspects  of  the  liquor  problem."  An  investigation  made  for  the 
Commitlee  of  Fifty,  under  the  direction  of  Henry  W.  Farnam,  secretary  of  the 
economic   subcommittee,   1899,   327  pages. 

f  "  Disease  and  Sin,"  American  Medical  Journal,  August  31  and  September 
7,  1901. 

0  Letter  from  Ellen  H.  Richards. 


FisHEH.J  NATIONAL  VITALITY.  743 

Section  2. — The  cost  of  conservation. 

It  costs  no  more  to  "  raise  "  a  man  capable  of  living  for  80  years  than  It  does 
to  "  grow  "  one  who  has  not  the  capacity  of  living  to  be  40  years  old.** 

We  have  seen  how  much  potential  value  of  life  is  now  allowed  to 
be  wasted  which  could  be  prevented.  But  the  question  remains,  What 
would  it  cost  to  conserve  it?  It  is,  of  course,  not  possible  to  answer 
this  question  definitely  and  fully.  The  best  we  can  do  is  to  point  out 
specific  instances  of  the  health  returns  which  follow  on  investments 
in  the  improvement  of  vital  conditions. 

The  following  examples  will  show  the  returns  which  may  be  ex- 
pected from  well-planned  expenditures  on  behalf  of  public  health: 

The  city  of  Pittsburg  is  just  installing  a  great  municipal  filter  plant  for  the 
purification  of  its  principal  water  supply,  at  an  expense  of  upward  of  $7,000,000. 
It  is  reasonable  to  estimate  that  in  a  year  or  two  this  should  eflect  a  saving  of 
100  deaths  a  year  from  typhoid  fever,  for  the  number  of  typhoid-fever  deaths 
of  late  years  has  been  400  or  more  yearly.  Valuing  these  lives  at  $5,000  each, 
as  is  customary,  the  saving  effected  by  the  purification  works  should  be  half  a 
million  dollars'  worth  of  human  life  annually,  making  the  building  of  the  filter 
a  sound  and  profitable  economic  as  well  as  humanitarian  measure.  But  if,  as 
Mr.  MacXutt  and  I  have  shown,  Hazen's  theorem  is  true,  then  for  every  100 
deaths  saved  from  typhoid  fever  at  least  200  will  be  saved  from  other  causes, 
which  means  at  least  $1,000,000  more  saved  to  the  city  of  Pittsburg  annually  of 
its  present  waste  of  human  life.* 

England  reckons  that  the  lives  saved  through  the  lowered  death  rate,  from 
iwhat  it  was  between  1SG6  and  1S75  to  what  it  became  in  the  period  reaching 
from  ISSO  to  1889,  amounted  to  858,804.  This  represents  on  the  English  basis 
of  the  per  capita  valuation  of  each  life  ($770)  a  social  capital  of  $650,000,000 
saved.  In  ten  years  England  has  more  than  regained  the  sum  spent  in  fifteen 
years  for  sanitary  improvements,  though  the  average  annual  expenditure  has 
been  $42,000,000.*^ 

The  achievement  of  Huddersfield,  England,  is  especially  noteworthy.  The 
average  number  of  deaths  of  infants  for  ten  years  had  been  310.  By  a  system- 
atic -education  of  mothers  the  number  was  in  1907  reduced  to  212.  The  cost  of 
saving  these  98  lives  was  about  $2,000.<* 

A  saving  of  infant  life  is  recorded  by  Doctor  Chapin  in  Providence : 

We  attempted  for  two  years  to  distribute  clean  milk  to  the  babies  of  the  poor, 
but  this  year  we  decided  that  the  money  could  better  be  spent  on  trained 
nurses.  Thus  far  we  have  expended  about  $900  for  this  purpose.  Two  hundred 
and  thirty-five  sick  children,  of  whom  very  many  were  very  sick,  have  been 
cared  for.  Of  these  only  20  have  died.  From  a  study  of  our  statistics  I  should 
!  judge  that  the  reduction  in  infant  mortality  effected  by  the  nurses  was  at  least 
'  25  deaths,  and  it  may  be  that  as  many  as  40  lives  were  saved.^ 

At  the  funeral  of  Maj.  Walter  Eeed,  the  man  who  did  so  much  to 
prove  the  correctness  of  Doctor  Finley's  discovery  that  the  mosquito 
is  the  carrying  agent  for  the  yellow-fever  germ,  Gen.  Leonard  Wood 

"T.  S.  Lambert:  "  Sources  of  Longevity,"  New  York,  1869,  p.  6. 

&W.  T.  Sedgwick:  "The  call  to  public  health,"  Science,  1908,  p.  198. 

Since  the  foregoing  was  written,  there  has  appeared  in  "  Charities,"  Februai-y 
6,  1909,  "  Thirty  Five  Years  of  Typhoid  "  by  Frank  E.  Wing,  in  which  it  is  shown 
'  that  there  were  in  1907,  in  Pittsburg,  4,921  cases  of  typhoid,  of  which  622  died; 
and  that  the  co.st  per  patient,  irrespective  of  the  lives  lost,  was  $128,  making  the 
cost  for  the  city  $694,000.  Reckoning  $4,000  as  the  value  of  each  life  lost, 
the  total  annual  money  cost  from  typhoid  in  Pittsburg  is  over  $3,000,000,  and, 
according  to  Hazen's  theorem,  already  mentioned,  this  is  probably  not  one-half 
nor  even  one-third  of  the  total. 

<*  Ditman,  loc.  cit.,  p.  4.  Taken  from  M.  G.  Dana ;  "  Itesults  of  municipal 
sanitation,"  Annals  of  Hygiene,  1896,  Vol.  II,  p.  391. 

^  Letter  from  Dr.  Charles  V.  Chapin, 

•  Ibid. 


744  REPORT   OF    NATIONAL  CONSERVATION   COMMISSION. 

declarcfl  that  this  di=cnvcry  is  saving  more  lives  annually  than  were 
lost  in  the  Cuban  war,  and  that  it  is  saving  the  commercial  interests 
of  the  world  a  greater  financial  loss  each  year  than  the  cost  of  the 
entire  Cuban  war." 

As  to  what  the  stamping  out  of  yellow  fever  means,  in  money 
terms,  the  following  is  significant: 

It  has  been  estimated  that  the  yellow  fever  epidemic  of  1878  invaded  132 
towns,  caused  a  mortality  of  15.9.14  persons,  and  that  the  pecuniary  loss  to  tho 
country  was  not  less  than  $100,000,000  in  gold.* 

Tlie  economic  loss  to  Philadelphia,  caused  by  the  smallpox  epidemic 
of  1871-72,  has  been  estimated  by  Doctor  Lee  at  $22,000,000.  This  in- 
cludes loss  to  travel  and  traffic  on  railroads,  loss  to  hotel  keepers, 
merchants,  and  manufacturers,  cost  of  care  of  sick,  loss  of  time,  and, 
the  expense  of  burial.  A  vaccine  bureau  with  physicians,  a  disinfect- 
ing station,  and  the  inauguration  of  a  campaign  of  education  capable 
of  forestalling  the  wliole  epidemic  would  have  cost  $700,000.^ 

It  is  reported  that  San  Francisco  plans  an  investment  of  $30,000,- 
000  in  stone  and  concrete  quays  to  prevent  rodents  from  infecting  the 
city,  and  this  is  regarded  by  experts  as  worth  while  many  times  over. 

In  respect  to  hook-worm  disease,  rating  the  earning  per  diem  of  the 
southern  farm  laborer  at  75  cents,  28  observers  report  that  average 
laborers  infected  with  hook-worms  earn  40  cents  per  diem.  Ten  ob- 
servers having  cotton-mill  practice  report  unanimously  that  the 
disease  is  very  prevalent  among  cotton-mill  laborers,  and  rating  the 
average  mill  laborers  at  $1.50  per  diem,  they  consider  75  cents  as  a 
fair  rating  for  hook-worm  bearing  laborers.'* 

It  would  be  difficult  to  even  roughly  estimate  the  cost  of  this  disease  to  the 
South,  but  from  wlint  we  Icnow  of  it  in  this  State  I  woulci  say  that  it  costs  South 
Carolina  not  less  than  $30,000,000  per  year,  and  this  inability  to  perform  regular 
and  efiioient  labor  is  the  smallest  part  of  the  cost.® 

It  has  been  figured  that  the  hook-worm  disease  of  the  South  could 
be  wiped  out  within  a  generation  f  through  the  expenditure  of  from 
one  to  two  millions  of  dolhirs  by  federal  and  state  agencies.  It  costs' 
about  15  to  75  cents  (wholesale)  for  drugs  to  cure  a  case  of  hook 
worms.  In  three  months  the  quantity  of  red  corpuscles  in  the  blood 
can  easily  be  increased  10  to  50  \y^v  cent,  according  to  the  severity  of 
the  case,  and  the*  absenteeism  of  the  victims  could  easily  be  reduced 
25  per  cent. 

Another  noteworthy  result  of  well-directed  sanitary  effort  is  the  reduction  of  i 
hook-worm  disease  in  Torto  Rico.  As  you  are  doubtless  aware,  this  disease 
causes  a  ti-emendous  lowering  of  the  physical  efficiency  of  the  people  of  thati 
island.  As  you  may  see  by  the  report  of  the  special  commission  for  3906  and 
1907  made  to  Governor  Post,  89,000  people  were  treated,  and  for  the  mosti 
part  cured,  for  54  cents  each.'' 

<»  Ditman,  loc.  cit,  p.  12. 

*  Walter  Wyman,  M.  D.,  "Quarantine  and  Commerce,"  address  before  Cincin-; 
nati  Commercial  Club,  October  15,  1898,  p.  8. 

'^  Ditman,  loc.  cit,  pp.  8-10,  from  Bissell,  A  Manual  of  Hygiene. 

^  Letter  from  Dr.  W.  J.  Burdell. 

«  William  Weston,  "Uncinariasis,"  South  Carolina  Medical  Association,  1908, 
p.  8. 

^  Dr.  Charles  W.  Stiles,  of  the  United  States  Public  Health  and  :\larine-Hos-i 
pital  Service,  who  has  studied  the  hook-worm  disease  more  thoroughly  than  any 
one  else  In  the  country. 

0  Letter  from  Doctor  Stiles. 

*  Letter  from  Charles  V.  Chapin,  1908, 


nsHER.]  NATIONAL.  VITALITT.  745 

Medical  inspection  in  our  schools  also  returns  large  dividends  on 
small  investments. 

Using  these  duta  as  a  basis,  we  have  the  annual  expenditure  for  medical 
Inspection  of  ^345,135  in  those  cities  from  which  we  have  succeeded  in  obtain- 
ng  data.  It  seems  probable,  although  this  is  frankly  a  guess,  that  the  total 
annual  expenditure  for  medical  inspection  of  schools  in  the  United  States  at 
:lie  present  time  is  perhaps  $500,000." 

The  money  saved  by  enabling  thousands  of  children  to  do  one  year's  work  in 
me  year,  instead  of  in  two  or  three  years,  would  greatly  exceed  the  total 
sxpense  of  examining  all  school  children  in  all  boroughs.* 

Doctor  Jessen  has  shown  that  the  cost  of  a  school  dental  clinic  in 
Grermany  is  only  one  mark  per  year  per  child."  The  cost  saved  must 
be  very  many  times  this  sum.  Dr.  Herbert  L.  Wheeler,  of  New 
York,  estimates  that  the  Children's  Aid  Dental  Clinic  in  New  York 

;ost  $342  for  the  last  fiscal  year  (35  cents  per  operation  and  70  cents 
per  ciiild  treated) .  He  reckons  that  the  neglect  of  these  slight  repairs 
«70uld  later  have  cost  far  more  in  dentistry,  as  well  as  over  $2,000 
worth  of  lost  time.     These  losses  are  of  course  of  minor  importance 

ompared  with  the  pain,  inconvenience,  and  secondary  effects  on 
lealth  and  efficiency  which  are  inevitably  associated  with  bad  teeth. 

Mr.  Edwin  Chadwick,  who  was  once  secretary  of  the  English  Na- 
ional  Board  of  Health,  stated  that  a  sanitary  "engineer  ought  to 

ontract  for  the  reduction  of  the  sickness  and  death  rate,  in  such  a 
';ity  as  Glasgow,  by  at  least  one-third,  for  a  penny  a  head  of  the 

ntire  population."  ^ 

It  is  necessary,  if  we  are  to  do  our  utmost,  to  spend  a  thousand  pounds  of 
public  money  on  this  task  where  we  now  spend  one  pound.  It  would  be  rea- 
sonable and  wise  to  expend  ten  million  pounds  a  year  of  our  revenues  on  the 
nvestigation  and  attempt  to  destroy  disease.  Actually  what  is  so  spent  is  a 
nere  nothing,  a  few  thousands  a  year.  Meanwhile  our  people  are  dying  by 
:housands  of  preventable  disease.* 

Mr.  Hiram  J.  Messenger,  actuary  of  the  Travelers  Insurance  Com- 
3any,  of  Hartford,  has  constructed  and  sent  me  a  table  showing  that 
ife  insurance  companies  could  probably  make  money  now  by  taking 
A  hand  in  the  public-health  movement,  with  the  purely  commercial 
)bject  of  reducing  their  death  losses.     He  says: 

This  table  shows  that  if  the  companies  were  to  expend  $200,000  a  year  for 
Jiis  purpose  and  as  a  result  should  decrease  their  losses  by  the  almost  insig- 
lificant  amount  of  twelve  one-hundredths  of  1  per  cent,  they  would  save  enough  to 
!Over  the  expense.  If  such  a  plan  as  this  were  placed  on  a  purely  scientific  basis 
ind  carried  out  by  good  business  methods  and  all  the  companies  pulled  together 
!or  the  common  good,  I  should  expect  a  decrease  in  death  claims  of  more  than  1 
)er  cent.  And  a  decrease  in  death  claims  of  1  per  cent  would  mean  that  the 
•ompanies  would  save  more  than  eight  times  as  much  as  they  expended  or  would 
uake  a  net  saving  of  more  than  seven  times  the  expense — which  would  be  about 
I  million  and  a  half  dollars  a  year. 

The  examples  given  show  tangible  returns  on  the  investment  of  sev- 
eral thousand  per  cent  as  a  rule.     AVliile  it  would  be  impossible  to 

"  Letter  from  Dr.  Luther  H.  Gulick. 

^  Sixty-third  Annual  Report  of  the  Association  for  Improving  the  Condition  of 
he  Poor,  New  York,  1906. 

<^  See  "Jahresbericht  der  Stadtischen  Schulzahnklinik  in  Strassburg,"  in 
)dontologische  Bliitter  12,  No.  15-16,  1907. 

'^  Transactions  of  the  British  Social  Science  Association,  1866,  p.  580.  Quoted 
)y  Dr.  Edward  Jarvis,  Political  Economy  of  Health,  Fifth  Report,  Mass.  Board 
)f  Health,  1874,  p.  367. 

»E.  Kay  Laukester,  "The  Kingdom  of  Man,"  New  York  (Holt),  1907,  p.  148. 


746  REPORT   OF    NATIONAL.  CONSERVATION   COMMISSION. 

state  in  general  terms  how  rich  a  return  lies  ready  for  public  or  pri- 
vate investments  in  good  health,  the  foregoing  examples  and  numer- 
ous others  show  that  the  rate  of  this  return  is  quite  beyond  the  dreams 
of  avarice.  Were  it  possible  for  the  public  to  realize  this  fact,  motives 
both  of  economy  and  of  humanity  would  dictate  immediate  and  gen- 
erous expenditure  of  public  moneys  for  improving  the  air  we  breathe, 
the  water  we  drink,  and  the  food  we  eat,  as  well  as  for  eliminating 
the  dangers  to  life  and  limb  which  now  surround  us. 

Chapter  XIII. — The  general  value  of  increased  vitality. 
Section  1. — Disease,  poverty,  and  crime. 

In  the  preceding  chapter  we  have  attempted  to  estimate  in  money 
the  preventable  wastes  from  disease  and  death.  Although  the  figures 
for  national  losses  strike  the  popular  imagination,  they  have  little 
significance ;  in  fact,  money  estimates  in  this  field,  even  when  made  on 
the  per  capita  basis,  are  of  little  value  except  as  emphasizing  the 
overwhelming  importance  of  human  vitality  compared  with  those 
interests  which  are  usually  measured  in  money.  It  is  impossible  in 
any  true  sense  to  measure  human  life  in  terms  of  dollars  and  cents." 

The  measure  of  life  ma}^  perhaps  be  found  in  hapjDiness,  or  the 
satisfactions  enjoyed  between  birth  and  death,  less  the  dissatisfactions. 

Is  life  worth  living?  has  been  a  much  asked  question,  especially  since 
Mr.  Mallock  wrote  a  book  with  that  title.  The  witticism  sometimes 
given  in  answer,  "  That  depends  upon  the  liver,"  is  true  in  both  of  its 
two  meanings.  A  life  of  happiness  is  always  worth  living,  and  a  life 
of  usefulness,  which  brings  happiness  to  others,  is  doubly  worth 
living. 

It  is  hardly  necessary  to  recount  all  the  conditions  which  tend  to 
produce  happiness.  No  one  would  question  that  the  most  funda- 
mental condition  of  all  is  health,  in  spite  of  exceptional  cases  in  which 
unhealthy  people  are  found  happy,  and  healthy  people  unhappy.  It 
would  be  impossible  to  express  in  exact  terms  the  extent  to  which  im- 
proved health  could  increase  human  happiness;  but  every  observer 
of  human  misery  among  the  poor  reports  that  disease  plays  the  lead- 
ing role.  Students  of  criminology  and  vice  agree  that  these  are 
chiefly  the  result  of  morbid  conditions  and  habits.  Health  reform 
brings  in  its  train  great  and  lasting  reductions  in  poverty,  criminality, 
and  vice. 

We  began  this  report  by  showing  the  relation  between  the  conser- 
vation of  health  and  the  conservation  of  wealth.  The  broadest  view 
of  this  relation  is,  as  Emerson  has  said,  that  "Health  is  the  first 
wealth,"  and  as  such  it  is  treated  by  many  economists.^ 

"  Even  as  a  measure  of  what  economists  call  *'  utility,"  a  money  estimate  is' 
misleading,  for  the  reason  that  the  "  marginal  utility  "  of  money  varies  with 
different  i)ersons.  For  instance,  a  week's  wages  of  $10  lost  to  a  poor  wage- 
earner  is  in  such  an  estimate  counted  on  a  par  with  an  expenditure  of  $10  by 
a  wealthy  invalid  for  a  dainty  morsel  of  food,  although  the  loss  in  "utility" 
to  the  former  is  vastly  greater  than  that  to  the  latter. 

*  Among  those  who  have  included  health  in  the  category  of  wealth  are! 
Davenant,  Petty,  Canard,  Say,  McCullough.  Roscher,  Wittstein,  Walras,  Engel,' 
Weiss,  Dargun,  Ofner,  Nicholson,  and  Pareto.  See  Irving  Fisher:  "The  Nature 
of  Capital  and  Income,"  New  York  (Macmillan),  1906,  p.  5. 


IIS  HER.]  NATIONAL  VITALITY.  747 

Without  enlarc-ing  or  insisting  upon  this  concept,  it  is  obvious  that 
by  the  conservation  of  health  we  may  ultiniatoly  save  billions  of 
dollars  of  wasted  values,  and  that  this  conservation  is  intimately 
related  to  conservation  of  all  other  kinds." 

We  have  alread}'  seen  the  vicious  circle  set  up  between  poverty  and 
disease,  each  of  which  tends  to  produce  the  other.  Metchnikoff ''  con- 
tends that  health  and  morality  are  correlative,  if  not  interchangeable, 
tin-ms.  A  similar  idea  has  been  elaborated  statistically  by  Dr.  George 
JNI.  Gould.^  The  subject  is  worth  much  further  study.  National 
efficiency  is  crippled  by  any  one  or  all  of  the  parts  of  the  vicious 
circle — disease,  poverty,  vice,  vagabondage,  crime.  It  would  be 
interesting  to  study  the  tramp  problem,  which  represents  an  enor- 
mous waste  of  labor  power,  in  relation  to  all  these  phenomena. 

Section  2. — Conservation  of  natural  resources. 

It  is  also  true  that  health  begets  Avealth,  and  vice  versa.  Whatever 
diminishes  poverty  or  increases  the  physical  means  of  welfare  has  the 
improvement  of  health  as  one  of  its  first  and  most  evident  effects. 
Therefore  an  important  method  of  maintaining  vital  efficiency  is  to 
conserve  our  natural  resources — our  land,  our  raw  materials,  our  for- 
ests, and  our  water.  Only  in  this  way  can  we  obtain  food,  clothing, 
'shelter,  and  the  other  means  of  maintaining  life.  Conversely,  the 
conservation  of  health  will  tend  in  several  ways  to  the  conservation 
of  wealth.  First  of  all,  the  more  vio-orous  and  lonff-lived  the  race, 
the  better  utilization  can  it  make  of  its  natural  resources.  The  labor 
power  of  such  a  race  is  greater,  more  intense,  more  intelligent,  and 
more  inventive. 

The  development  of  our  natural  resources  in  the  future  will  be 
more  dependent  on  technical  invention  ^  than  upon  the  mere  abun- 
dance of  materials. 

Just  as  in  warfare  it  is  not  so  much  the  gun  as  the  man  behind 
the  gun  that  makes  for  success,  so  in  industr}^,  as  Doctor  Shadwell  ® 
has  shown,  skill,  knowledge,  and  inventiveness  are  the  chief  factors 
in  determining  commercial  success  and  supremacy.  The  backward 
nations,  like  China,  are  characterized  by  lack  of  modern  inventions. 
The  nations  which  are  industrially  most  advanced  have  the  ^ailwa3^ 
'the  steamship,  the  power  loom,  metal  working,  and  innumerable  arts 
and  crafts.  The  change  of  Japan  from  a  backward  to  a  forward 
nation  is  at  bottom  the  introduction  of  inventions.  If  conservation 
prevents  lessened  fertilit}^,  invention  makes  two  blades  of  grass  grow 
where  one  grew  before. 

Future  industrial  competition  will  be  increasingly  a  contest  of  in- 
vention. The  world  rivalry  to  develop  the  best  system  of  wireless 
telegraphy  or  the  best  airships  is  but  one  example.  The  future  will 
see  the  greatest  strides  taken  by  the  nation  which  is  the  most  invent- 

"See  Edward  Devine,  "Efficiency  and  Relief,"  New  Yoric  (Mncmillan).  1006. 

*  "  Prolongation  of  Life,"  p.  318. 

<^  "  Disease  and  sin,"  American  Medical  Journal,  Aug.  31  and  Sept.  7,  1901. 

^  Since  the  above  was  written.  President  Charles  S.  Howe,  of  Cleveland,  has 
^presented  this  point  in  detail.  See  "The  function  of  the  engineer  in  the  cou- 
i serration  of  the  natural  resources  of  the  country,"  Science,  Oct.  23,  1908. 

« Arthur  Shadwell  in  his  admirable  "Industrial  Efficiency"  (2  vols.).  Lon- 
lon  (Longmans),  190G. 

S.  Doc.  419,  61-2 9 


748  REPORT    OF   NATIONAL   CONSERVATION    COMMISSION. 

ive.  Kow,  the  primary  condition  of  invention  is  vitality,  a  clea 
brain  in  a  normal  body.  It  is  no  accident  that  Edison  is  a  healtl 
culturist,  or  that  Krupp,  Westinfjhouse,  and  other  pioneers  in  Indus 
trial  development  have  been  men  of  vigor  of  mind  and  body. 

Finally,  the  conservation  of  health  will  promote  the  conservatioi 
of  other  resources  by  keeping  and  strengthening  the  faculty  of  fore 
sight.  One  cause  of  poverty  in  the  individual  and  the  nation  is  lac] 
of  forethought." 

One  of  the  first  symptoms  of  racial  degenerac}'  is  decay  of  fore 
sight.  Normal,  healthy  men  care  for  and  provide  for  their  descend 
ants.  A  normal,  healthy  race  of  men,  and  such  alone,  will  enac 
tlie  laws  or  develop  the  public  sentiment  needed  to  conserve  natura 
resources  for  generations  yet  unborn.  AMien  in  Rome  foresigh 
was  lost,  care  for  future  generations  practically  ceased.  Physica 
degeneracy  brought  with  it  moral  and  intellectual  degeneracy.  In 
i-tead  of  conserving  their  resources  the  spendthrift  Romans,  from  th; 
emperor  down,  began  to  feed  on  their  colonies  and  to  eat  up  theii 
capital.  Instead  of  building  new  structures  they  used  their  olc 
Coliseum  as  a  quarry  and  a  metal  mine.'' 

The  problem  of  the  conservation  of  our  natural  resources  is  there 
fore  not  a  series  of  independent  problems,  but  a  coherent  all-embra 
cing  whole.  If  our  nation  cares  to  make  any  provision  for  its  grand 
children  and  its  grandchildren's  grandchildren,  this  provision  mus' 
include  conservation  in  all  its  branches — but  above  all,  the  con^ervai 
tion  of  the  racial  stock  itself. 

Chapter  XIV. — Things  which  need  to  he  done. 
Section  1. — Eniaucration  of  piincipal  measures. 

In  order  that  American  vitality  may  reach  its  maximum  devel- 
opment, many  things  need  to  be  done.  Among  them  are  the  fol- 
lowing: 

1.  The  National  Government,  the  States,  and  the  municipalities 
should  steadfastly  devote  their  energies  and  resources  to  the  protecj 
tion  of  the  people  from  disease.  Such  protection  is  quite  as  properlj 
a  governmental  function  as  is  protection  from  foreign  invasion,  froir 
criminals,  or  from  fire.  It  is  both  bad  policy  and  bad  economj 
to  leave  this  work  mainly  to  the  weak  and  spasmodic  efforts  ol 
cltarity,  or  to  the  philanthropy  of  physicians. 

2.  The  National  Government  should  exercise  at  least  three  public 
lioalth  functions:  First,  investigation;  second,  the  dissemination  o: 
information;  third,  administration. 

It  should  remove  the  reproach  that  more  pains  are  now  taken  t( 
protect  the  health  of  farm  cattle  than  of  human  beings.  It  shoul(] 
|)i()vide  more  and  greater  laboratories  for  research  in  preventive 
medicine  and  public  hygiene.  Provision  should  also  be  made  fo? 
better  and  more  universal  vital  statistics,  without  which  it  is  impos^ 
sible  to  know  the  exact  conditions  in  an  epidemic,  or,  in  general, 
the  sanitary  or  insanitary  conditions  in  any  part  of  the  countrjj 

"See  Irving  Fisher:  "The  Rate  of  Interest,"  New  York    (Macniillan),  1007 
ft  See  John   Rae :  "Sociological   Theory  of  Capital,"  edited   by   Prof.   C.   W 
Mixter,  New  York  (Macmilluu),  1905. 


risHEB.]  NATIONAL  VITALITY.  749 

It  should  aim,  as  should  state  and  municipal  Ipirislation,  to  procure 
adequate  registration  of  births,  statistics  of  which  are  at  present 
lacking  throughout  the  United  States. 

The  National  Government  should  prevent  transportation  of  dis- 
ease from  State  to  State  in  the  same  way  as  it  now  provides  for 
foreign  quarantine  and  the  protection  of  the  nation  from  the  impor- 
tation of  disease  by  foreign  immigrants.  It  should  provide  for  the 
protection  of  the  passenger  in  interstate  railway  travel  from  infection 
by  his  fellow-passengers  and  from  insanitary  conditions  in  sleeping 
3ars,  etc. 

It  should  enact  suitable  legislation  providing  against  pollution  of 
interstate  streams. 

It  should  provide  for  the  dissemination  of  information  in  regard 
to  the  prevention  of  tuberculosis  and  other  diseases,  the  dangers  of 
impure  air,  impure  foods,  impure  milk,  imperfect  sanitation,  ventila- 
tion,  etc.     Just   as  now   the   Department   of   Agriculture  supplies 
:  specific  information  to  the  farmer  in  respect  to  raising  crops  or  live 
1  stock,  so  should  one  of  the  departments,  devoted  principally  to  health 
i  and  education,  be  able  to  provide  every  health  officer,  school-teacher, 
;  employer,  physician,  and  private  family  with  specific  information  in 
rcirard  to  public,  domestic,  and  personal  hygiene. 

It  should  provide  for  making  the  national  capital  into  a  model 

sanitary  city,  free  from   insanitary  tenements  and  workshops,  air 

pollution,  water  pollution,  food  pollution,  etc.,  with  a  rate  of  death 

i  and  a  rate  of  illness  among  infants  and  among  the  population  gen- 

!  jrally  so  low  and  so  free  from  epidemics  of  typhoid  or  other  diseases 

as  will  arouse  the  attention  of  the  entire  country  and  the  world. 

There  should  be  a  constant  adaptation  of  the  pure-food  laws  to 
changing  conditions.  Meat  inspection  and  other  inspection  should  be 
30  arranged  as  to  protect  not  only  foreigners,  but  our  own  citizens. 
The  existing  health  agencies  of  the  Government  should  be  concen- 
trated in  one  department,  better  coordinated,  and  given  more  powers 
and  appropriations. 

3.  State  boards  of  health  and  state  legislation  should  provide  for 
the  regulation  of  labor  of  women,  should  make  physiological  condi- 
tions for  women's  work  and  prevent  their  employment  before  and 
after  childbirth;  should  regulate  the  age  at  which  children  shall  be 
employed,  make  reasonable  regulations  in  regard  to  hours  of  labor 
and  against  the  dangers  in  hazardous  trades,  and  especially  against 
the  particular  dangers  of  dust  and  poisonous  chemicals;  should  make 
regulations  for  sanitation  and  provide  inspection  of  factories,  schools, 
asylums,  prisons,  and  other  public  institutions.  AVhere  municipalities 
have  not  the  powers  to  enact  the  legislation  above  mentioned  with 
reference  to  local  conditions,  the  necessary  legislation  or  authority 
should  be  provided  by  the  State.  Or  where  by  reason  of  the  small 
I  size  of  the  town  no  efficient  local  action  is  possible,  the  State  should 
'  exercise  the  necessary  functions.  It  should  in  such  cases  advise  and 
supervise  local  boards  of  health.  It  should  have  an  engineering  de- 
partment and  advise  regarding  the  construction  of  sewers  and  water 
supplies.  Pollution  of  such  supplies,  unless  entirely  local,  should  be 
prevented  by  the  State,  which  should  be  equipped  with  laboratories 
for  the  analysis  of  water,  milk,  and  other  foods.  Suitable  legislation 
should  be  passed  regulating  the  sale  of  drugs,  especially  preparations 


750  REPORT    OF    NATIONAL  CONSERVATION    COMMISSION. 

contiiininnr  cocaine,  opium,  or  alcohol.  Legislation — not  too  far  in 
advance  of  public  sentiment  needed  to  enforce  it — should  be  passed 
regulating  the  sale  of  alcoholic  beverages.  State  registration  of 
births,  deaths,  and  cases  of  illness  should  be  much  more  general  and 
efficient  than  at  present. 

4.  Municipal  boards  of  health  need  to  have  more  powers  and 
greater  appropriations;  less  political  interference  and  better  trained 
health  oflicers;  more  support  in  public  opinion.  Their  ordinances  in 
regard  to  expectoration,  notification  of  infectious  disease,  etc.,  should' 
be  better  enforced  by  the  police  departments. 

More  legislation  should  be  advocated,  passed,  and  enforced  to 
the  end  that  streets  may  be  kept  clean,  garbage  jiroperly  removed, 
sewage  properl}'^  disposed  of,  air  pollution  of  all  kinds  prevented, 
vrhether  by  smoke,  street  dust,  noxious  gases,  or  any  other  source. 
Noises  also  should  be  lessened. 

Municipalities  need  also  to  take  measures  to  prevent  infection  being 
carried  by  flies,  mosquitoes,  other  insects  and  vermin,  and  by  prosti- 
tution. They  need  to  guard  with  greater  care  the  water  supply,  and 
in  many  cases  to  filter  it;  they  should  make  standards  for  milk  pu- 
rity and  enforce  them;  they  should  also  regularly  inspect  other  foods 
exposed  for  sale;  provide  for  sanitary  inspection  of  local  slaughter- 
houses, dairies,  shops,  lodging  and  boarding  houses,  and  other  estab- 
lishments within  the  poAver  of  the  particular  municipality;  they 
should  make  and  enforce  stricter  building  laws,  especially  as  relatingi 
to  tenements,  to  the  end  that  dark-room  tenements  may  be  eliminated 
and  all  tenements  be  provided  wdth  certain  minimum  standard  re- 
quirements as  to  light,  air,  and  sanitary  arrangements. 

5.  School  children  should  be  medically  inspected  and  school 
hygiene  universally  practiced.  This  involves  better  protection 
against  school  epidemics,  better  ventilation,  light,  and  cleanliness  of 
the  schoolroom,  the  discovery  and  correction  of  adenoids,  eye  strain. 
and  nervous  strain  generally,  and  the  provision  for  playgrounds. 
Sound  scientific  hygiene  should  be  taught  in  all  schools,  public,  pri- 
vate, normal,  and  technical,  as  also  in  colleges  and  universities. 

6.  The  curricula  of  medical  schools  should  be  rearranged  with  a 
greater  emphasis  on  prevention  and  on  the  training  of  health  officers. 
Sanatoria  and  hospitals,  dispensaries,  district  nursing,  tuberculosis 
classes,  and  other  semipublic  institutions  should  be  increased  in  num- 
ber and  improved  in  quality.  The  medical  profession,  keeping  pace 
with  these  changes,  should  be  the  chief  means  of  conveying  their 
benefits  to  the  public.  Universities  and  research  institutions  need 
to  take  up  the  study  of  hygiene  in  all  its  branches.  Now  that  the 
diseases  of  childhood  are  receiving  attention,  the  next  step  should 
be  to  study  the  diseases  of  middle  life.  These  are  diseases,  to  a  large 
extent,  of  nutrition  and  circulation,  and  consequently  these  subject- 
should  receive  special  attention.  Intelligent  action  must  rest  on 
knowledge,  and  knowledge  of  preventing  disease  is  as  yet  extremely 
imperfect. 

7.  In  industrial  and  commercial  establishments  employers  may 
greatly  aid  the  health  movement,  and  in  many  cases  make  their  phi- 
lanthropy self-supporting  by  providing  social  secretaries,  lunch  and 
rest  rooms,  physiological  (generally  shorter)  hours  of  work,  pro- 
vision for  innocent  amusements,  seats  for  women,  etc. 


I 


!siii:r.]  national  VITALITY.  751 

Life  insurance  companies  could  properly  and  with  much  profit 
■liib  together  to  instruct  their  risks  in  self-care  and  secure  general 
cgislation  and  enforcement  of  legislation  in  behalf  of  public  health. 

8.  The  present  striking  change  in  personal  habits  of  living  should 
)c  carried  out  to  its  logical  conclusion  until  the  health  ideals  and  the 
deals  of  athletic  training  shall  become  universal.  This  chan"-e  in- 
.nlves  a  quiet  revolution  in  habits  of  living,  a  more  intelligent  utili- 
■:ntion  of  one's  environment,  especially  in  regard  to  the  condition  of 
he  air  in  our  houses,  the  character  of  the  clothes  we  wear,  of  the 
iite  and  architecture  of  the  dwelling  with  respect  to  sunlight,  soil, 
ventilation,  and  sanitation,  the  character  of  food,  its  cooking,  the 
i«e  of  alcohol,  tobacco,  and  drugs,  and  last,  but  not  least,  sex  hygiene 
n  all  its  bearings. 

9.  The  fight  against  disease  will  aid  in  the  fight  against  pauper- 
sm  and  crime.  It  is  also  true  that  any  measures  which  tend  to  elimi- 
late  poverty,  vice,  and  crime  will  tend  to  improve  sanitary  condi- 
tions. 

10.  Finally,  eugenics,  or  hygiene  for  future  generations,  should  be 
studied  and  gradually  put  in  practice.  This  involves  the  prohibi- 
tion of  flagrant  cases  of  marriages  of  the  unfit,  such  as  syphilitics. 

4he  insane,  feeble-minded,  epileptics,  paupers,  or  criminals,  etc.  The 
example  of  Indiana  in  this  regard  should  be  considered  and  followed 
DV  other  States,  as  also  in  regard  to  the  unsexing  of  rapists,  criminals. 
idiots,  and  degenerates  generally.  A  public  opinion  should  be 
=iroused  which  will  not  only  encourage  healthy  and  discountenance 
degenerate  marriages,  but  will  become  so  embedded  in  the  minds  of 
the  rising  generation  as  will  unconsciously,  but  powerfully,  affect 
their  marriage  choices. 


O 


THE  ^EED 

FOR 

HEALTH    INSURANCE 


IRVING   FISHER 

PROFESSOR,   POLITICAL  ECONOMY,   YALE  UNIVERSITY 


PRESIDENTIAL   ADDRESS 

Delivered  at  the  Tenth  Annual  Meeting  of  the  American  Association 

for  Labor  Legislation,  in  Joint  Session  with  the  American 

Economic  Association,  the  American  Sociological 

Society,    and   the  American    Statistical 

Association,  Columbus,  Ohio. 

December  27,   1916. 


From 

The  American  Labor  Legislation  Review 

Vol.  VII,  No.  1,  1917 


Estate  of  Rudolph  iLekz 

Printer 

Bible  House.  New  York 


I 


i 

I 
I 


THE  NEED  FOR  HEALTH  INSURANCE 


Irving  Fisher 
Professor,  Political  Economy,  Yale  University 


In  the  last  six  months,  through  the  efforts  of  the  American 
Association  for  Labor  Legislation,  a  consciousness  of  the  imperative 
need  in  this  country  for  health  insurance  has  dawned  upon  think- 
ing Americans.  Within  another  six  months  it  will  be  a  burning 
question  in  many  states.  As  Dr.  Blue,  surgeon  general  of  the 
United  States  Public  Health  Service,  has  said,  it  is  the  next  great 
step  in  social  legislation  in  this  country. 

At  present  the  United  States  has  the  unenviable  distinction  of 
being  the  only  great  industrial  nation  without  compulsory  health 
insurance.  For  a  generation  the  enlightened  nations  of  Europe 
have  one  after  another  discussed  the  idea  and  followed  discussion 
by  adoption.  It  has  constituted  an  important  part  of  the  policy 
and  career  of  some  of  Europe's  greatest  statesmen,  including  Bis- 
marck and  Lloyd  George.  Germany  showed  the  way  in  1883 
under  the  leadership  of  Bismarck.  This  act  was  the  first  step  in 
her  program  of  social  legislation.  Her  wonderful  industrial  pro- 
gress since  that  time,  her  comparative  freedom  from  poverty, 
reduction  in  the  death  rate,  advancement  in  hygiene,  and  the  physi- 
cal preparedness  of  her  soldiery,  are  presumably  due,  in  consider- 
able measure,  to  health  insurance. 

Following  the  example  of  Germany,  health  insurance  was 
adopted  successively  by  Austria,  Hungary,  Luxemburg,  Norway, 
Serbia,  Great  Britain,  Russia,  Rumania,  and  Holland.  Other  coun- 
tries have  adopted  a  subsidized  voluntary  system,  namely,  France, 
Belgium,  Switzerland,  Denmark,  Sweden,  and  Iceland.  Thus  the 
only  European  countries  which,  like  the  United  States,  are  without 
any  general  system  are  Italy,  Spain,  Portugal,  Greece,  Bulgaria, 
Albania,  Montenegro,  and  Turkey. 

Because  we  have  a  democratic  form  of  government  we  have 
peacefully  assumed  that  our  civilization  is  more  advanced  than 
others,  but  while  we  have  rested  complacently  on  our  oars,  other 
nations  have  forged  ahead  of  us.  The  war  has  at  last  startled 
us  out  of  our  Rip  Van  Winkle  slumber,  and  we  are  now  passing 
through  a  period  of  national  self-examination. 


There  are  special  reasons  to  hope  that  health  insurance  may 
win  favor  rapidly.  The  war  has  made  labor  scarce  and  therefore 
dear.  This  fact  will  make  not  only  for  high  wages,  but  also  for  the 
conservation  of  labor.  Students  of  the  history  of  slavery  find  that 
when  slaves  were  abundant  and  cheap,  masters  worked  them  to 
death  and  replaced  them  when  worn  out.  Consequently,  cruelty  was 
condoned  and  fashionable.  On  the  other  hand,  when  slaves  were 
scarce  and  dear,  the  masters  took  good  care  of  them  and  a  humani- 
tarian sentiment  developed  to  correspond.  I  believe  it  to  be  a 
correct  economic  portent  that  the  world  is  about  to  enter  upon  a 
period  of  life  conservation.  The  war  has  for  a  time  withdrawn  much 
of  the  world's  labor  supply  and  destroyed  and  maimed  a  large  part 
of  that  which  it  has  withdrawn.  The  world  will  seek  the  greatest 
possible  salvage  out  of  the  wreck. 

This  impulse  to  conserve  has  at  first  been  felt  in  terms  not 
of  industry,  but  of  military  preparedness.  The  strong  impetus 
toward  preparedness  of  all  kinds  has  been  the  result.  Witness 
the  recent  laws  in  New  York  for  compulsory  physical  training 
in  the  public  schools.  Health  insurance  and  other  measures  for 
health  conservation  will  in  turn  be  furthered  by  the  same  impulse 
toward  conservation. 

Fortunately  we  have  already  taken  one  step  in  a  social  insur- 
ance program.  After  a  long  and  uphill  fight,  workmen's  compen- 
sation has  had  a  belated  recognition  in  America.  The  American 
Association  for  Labor  Legislation  ^vas  foremost  in  this  fight,  and 
now  at  last  it  is  ready  for  a  similar  fight  to  secure  workmen's 
health  insurance.  For  four  years  an  able  committee  of  this  Asso- 
ciation has  been  studying  American  conditions  and  foreign  health 
insurance  acts,  and  constructing  a  standard  bill.  This  bill,  with 
some  variations,  has  been  introduced  into  the  state  legislatures  of 
Massachusetts,  New  York,  and  New  Jersey,  and  commissions  to 
consider  the  subject  have  been  appointed  in  Massachusetts  and 
California  and  are  expected  to  report  in  January.  It  is  significant 
that  so  large  were  the  throngs  which  attended  the  public  hearing 
of  the  Massachusetts  commission  on  October  3  that  the  meeting 
place  had  to  be  twice  changed  during  the  hearing  to  larger  quarters. 
During  the  ensuing  year  it  is  expected  that  the  bill  will  be  intro- 
duced in  about  twenty  state  legislatures. 

The  United  States  Public  Health  Service  has  issued  a  special 
study  on  Health  Insurance  by  Dr.  B.  S.  Warren  and  Edgar  Syden- 
stricker.  The  American  Medical  Association  has  a  working  com- 
mittee on  health  insurance  of  which  Alexander  Lambert  is  chair- 
man and  L  M.  Rubinow  secretary.    This  association  has  published 


a  report  on  social  insurance.  Several  medical  societies,  including 
the  Pennsylvania  State  Medical  Society  and  the  State  Medical 
Society  of  Wisconsin,  and  several  public  health  associations,  have 
endorsed  the  principle  of  health  insurance.  The  American  Associa- 
tion for  the  Study  and  Prevention  of  Tuberculosis  and  many  of 
its  affiliated  organizations  have,  through  public  meetings  and  other- 
wise, helped  the  movement.  A  number  of  charitable  organizations 
have  also  favored  the  idea  and  forty-five  organizations  of  various 
natures,  including  the  American  Academy  of  Medicine,  the  Inter- 
national Association  of  Industrial  Accident  Boards,  the  National 
Conference  of  Charities  and  Correction,  the  New  York  Chamber 
of  Commerce,  and  the  American  Public  Health  Association  have 
appointed  committees  to  study  and  report  upon  health  insurance. 

The  federal  Commission  on  Industrial  Relations  recommended 
health  insurance.  In  accepting  favorably  the  report  on  health  insur- 
ance of  its  industrial  betterment  committee  the  National  Associa- 
tion of  Manufacturers  at  its  annual  meeting  last  May  put  itself 
en  record  as  favoring  the  project.  The  chairman  of  the  same  com- 
mittee stated  in  July,  1914:  "I  give  it  as  my  opinion  that  sickness 
insurance  of  some  kind,  with  compulsory  contribution  on  the  part 
of  employers,  will  be  enacted  into  law  by  many  states  of  the  union 
within  the  next  five  years."  The  Associated  Manufacturers  and 
Merchants  of  New  York  State  have  expressed  their  approval. 

Many  trade  unions  have  taken  up  the  subject.  Some  have 
strongly  favored  the  idea ;  a  few  leaders  have  vigorously  opposed 
it,  apparently  because  of  a  groundless  fear  that  in  some  way  the 
power  of  the  labor  unions  would  be  lessened.  Thus  some  oppose 
health  insurance  as  they  at  one  time  opposed  compulsory  work- 
men's compensation.  On  the  other  hand  several  international 
unions,  including  the  International  Typographical  Union,  have  defi- 
nitely gone  on  record  as  favorable.  State  federations  of  labor  in 
Ohio,  New  Jersey,  Massachusetts,  Missouri,  Nebraska,  and  Wis- 
consin are  favorable.  A  number  of  local  trade  unions  have  taken 
favorable  action.  Many  individual  labor  leaders  of  prominence 
have  definitely  approved  it;  these  include  John  Mitchell,  Ignatius 
McNulty,  Van  Bittner,  James  H.  Maurer,  Andrew  Furuseth,  S. 
E.  Heberling,  John  B.  Lennon,  James  O'Connell,  Austin  B.  Garret- 
son,  William  Green,  and  James  Duncan. 

The  cordial  and  almost  unprecedented  welcome  which  this 
movement  has  received  in  spite  of  the  opposition  of  strong  vested 
interests  and  their  industrious  and  insidious  efforts  to  misrepresent 
and  injure  the  movement  would  seem  to  indicate  that  the  time  for 
health  insurance  in  the  United  States  is  ripe. 


The  plan  as  put  forth  by  the  American  Association  for  Labor 
Legislation  is  fully  described  in  its  draft  of  a  standard  bill  and 
defended  in  its  Brief  for  Health  Insurance.  The  bill  proposes  the 
obligatory  insurance  of  substantially  all  workingmen  and  women. 
In  case  of  sickness  the  insured  will  receive  medical  or  surgical 
service,  medicines,  and  nursing,  and  a  cash  benefit  amounting  to 
two-thirds  of  the  weekly  wages  of  the  insured  for  the  period  of 
illness  up  to  six  months.  Maternity  benefits  are  provided  for 
childbirth,  and  funeral  benefits  for  death. 

Benefits  are  paid  for  at  cost  by  the  joint  contributions  of  the 
insured  employee,  his  employer,  and  the  state.  The  cost  to  the 
employee  will  average  about  1^  per  cent  of  his  wages.  The  cost 
to  the  employer  will  be  an  equal  amount,  while  the  state  will  pay 
half  as  much  as  either  the  employer  or  the  employee.  These  are 
the  main  points  covered  in  the  standard  bill.  I  am  here  concerned, 
however,  not  with  the  merits  of  this  particular  plan  but  with  the 
need  of  some  plan  of  universal  health  insurance  for  workmen. 

The  need  for  health  insurance,  like  that  for  most  other  forms 
of  insurance,  is  twofold.  There  is  the  need  of  indemnification  against 
loss,  and  the  need  of  diminishing  the  loss  itself. 

Indemnification  is  the  essence  of  the  insurance  principle.  It 
spreads  the  loss  of  each  person  in  a  group  over  them  all.  For  each 
individual  it  converts  large  fluctuating  haphazard  losses  into  small 
regular  and  certain  costs.  Insurance  aims  to  reduce  fluctuations — 
to  make  the  income  stream  more  steady.  It  is  more  economical  to 
pay  a  little  premium  for  fire  insurance  each  year  than  to  suffer  a 
big  loss  when  the  fire  comes.  This  insurance  principle  is  of  the 
greatest  importance  in  economics  and  in  business.  The  well-to-do 
have  long  made  use  of  it  in  fire  insurance,  marine  insurance,  life 
insurance,  fidelity  insurance,  plate  glass  insurance,  steam  boiler 
insurance,  and,  to  some  extent,  accident  and  health  insurance.  The 
capitalist  has  long  endeavored  to  eliminate,  or  at  least  to  reduce, 
every  determinable  risk.  But  the  curious  and  melancholy  fact  is  that 
outside  of  workmen's  compensation  the  poor  in  this  country  have 
received,  as  yet,  very  little  benefits  from  the  application  of  the  in- 
surance principle.  Yet  it  is  the  poor  whose  need  of  health  insur- 
ance is  greatest,  and  for  two  important  reasons.  One  is  that  the 
worker  is  more  likely  to  lose  his  health  than  the  capitalist ;  for  it 
is  well  known  from  several  lines  of  research  that  the  death  rate, 
and  therefore  the  sickness  rate,  prevailing  among  the  poor  is  from 
two  to  three  times  that  prevailing  among  the  well-to-do.  The  other 
reason  is  that  any  loss  from  sickness  is  a  far  more  vital  matter 


to  the  poor  than  to  the  rich.  That  low-paid  workingmen  seldom 
insure  against  illness  is  undoubted. 

No  very  exact  or  recent  estimate  on  this  point  seems  to  be 
available,  but  according  to  a  study  of  the  Connecticut  Bureau  of 
Labor  Statistics  in  1891  the  great  bulk  of  membership  in  fra- 
ternal societies  was  at  that  time  made  up  of  the  well-to-do;  only 
a  small  fraction,  from  one-sixth  to  one-third,  consisted  of  "low- 
paid  mechanics  and  clerks."  Moreover,  these  societies  do  not 
always  provide  health  insurance.  Certain  it  is  that  as  yet  the 
amount  of  voluntary  health  insurance  in  the  United  States  such 
as  that  under  fraternal  societies,  labor  unions,  establishment  funds, 
and  insurance  companies,  covers  only  a  small  fraction  of  working- 
men  and  women.  Judging  from  the  tentative  estimates  of  Rubinow, 
only  about  5  per  cent  of  our  workmen  needing  insurance  actually 
have  it.  The  other  95  per  cent  have  been  deterred  by  the  high  cost 
of  such  insurance  under  the  voluntary  system,  by  their  lack  of 
appreciation  of  its  benefits,  by  the  inertia  of  custom,  and  by  the 
sheer  desperation  of  poverty. 

To  ascertain  the  exact  extent  of  health  insurance  in  the  United 
States  we  need  further  investigation,  but  we  know  with  certainty 
that  the  amount  is  small.  Even  in  England,  where  friendly  soci- 
eties have  had  voluntary  health  insurance  for  generations  and  devel- 
oped it  far  beyond  the  United  States  or  any  other  country,  the 
number  of  the  insured  was  never  half  that  to  be  reached  by  the 
compulsory  system.  This  was  demonstrated  by  the  fact  that  when 
the  compulsory  system  was  actually  introduced  in  1911  the  number 
of  the  insured  was  at  once  more  than  doubled.  Presumably  the 
half  that  needed  it  most  was  the  half  that  lacked  it  until  the  uni- 
versal system  was  adopted.  From  these  facts  it  is  apparent  that 
the  present  insurance  facilities  in  the  United  States  are,  and,  as 
far  as  we  can  see,  always  will  be  hopelessly  inadequate. 

It  is  also  true  that  millions  of  American  workmen  cannot  at 
present  avail  themselves  of  necessary  medical,  surgical  and  nursing 
aid.  When  they  most  need  it  they  cannot  pay  for  it.  The  Rochester 
survey  of  the  Metropolitan  Life  Insurance  Company  showed  that 
39  per  cent  of  the  cases  of  illness  did  not  have  a  physician  in 
attendance. 

Workmen's  health  insurance  is  like  elementary  education.  In 
order  that  it  shall  function  properly  it  needs  must;  be  universal, 
and  in  order  to  be  universal,  it  must  be  obligatory.  In  regard  to 
obligatory  military  training  it  has  been  said  that  what  America 
most  needs  to-day  is  a  higher  appreciation  of  obligation  and  that 
without  it  we  shall  ever  be  a  drifting,  weak,  and  inefficient  nation. 


The  case  for  compulsory  health  insurance  is,  however,  far  clearer 
than  that  for  compulsory  military  training.  In  health  insurance, 
as  in  education,  we  are  dealing  not  with  obligatory  burdens,  but 
with  obligatory  benefits. 

Certain  interests  which  would  be,  or  think  they  would  be, 
adversely  affected  by  health  insurance  have  made  the  specious 
plea  that  it  is  an  un-American  interference  with  liberty.  They  for- 
get that  compulsory  education,  though  at  first  opposed  on  these 
very  grounds,  is  highly  American  and  highly  liberative,  that  pro- 
hibitory laws  on  various  subjects  such  as  habit-forming  drugs 
and  even  alcohol  have  introduced  liberative  compulsions  in  many 
states  in  America,  and  that  workmen's  compensation  acts  have 
introduced  liberative  compulsion  in  this  very  field  of  workingmen's 
insurance.  The  truth  is  that  the  opponents  of  compulsory  health 
insurance  are  in  every  case,  as  far  as  I  can  discover,  subject  to 
some  special  bias.  They  grasp  at  the  slogan  of  liberty  as  a  sub- 
terfuge only. 

Oh  liberty!  liberty!  How  many  crimes  are  committed  in  thy  name! 

According  to  the  logic  of  those  now  shedding  crocodile  tears 
over  health  insurance  we  ought,  in  order  to  remain  truly  American 
and  truly  free,  to  retain  the  precious  liberties  of  our  people  to  be 
illiterate,  to  be  drunk,  and  to  suffer  accidents  without  indemnification, 
as  well  as  to  be  sick  without  indemnification.  In  fact,  if  compulsory 
health  insurance  is  tyranny,  all  labor  laws,  all  tenement  laws,  all 
health  laws,  all  pure  food  laws,  even  all  laws,  are  tyranny.  In  fact, 
all  laws  are  an  interference  with  some  one's  liberty,  even  laws 
against  vice  and  crime.  It  is  the  nature  of  the  Law  to  restrict. 
But  it  is  by  the  compelling  hand  of  the  law  that  society  secures 
liberation  from  the  evils  of  crime,  vice,  ignorance,  accidents,  un- 
employment, invalidity,  and  disease. 

We  have  already  seen  that  most  of  the  enlightened  and  pro 
gressive  nations  of  the  world  have,  one  after  another,  adopted  com- 
pulsory health  insurance.  This  would  not  have  happened  if  it  were 
a  real  interference  with  liberty.  England,  the  most  liberty  loving 
of  nations,  the  home  of  laissez-faire,  adopted  the  compulsory  sys- 
tem after  careful  and  deliberate  study  of  the  German  and  other 
systems. 

It  is  also  noteworthy  that  where,  as  in  Switzerland,  France, 
and  Belgium,  the  half-way  stage  has  been  reached  of  a  subsidized 
voluntary  system,  the  tendency  has  been  to  convert  this  into  a  com- 
pulsory system.  Such  a  change  was  about  to  be  put  on  the  statute 
books  in  Belgium  when  the  present  war  broke  out. 


In  addition  to  the  primary  advantage  of  universality,  there 
are  incidental  advantages  in  the  compulsory  system.  There  are 
important  economies  in  administration  owing  to  the  elimination  of 
the  cost  of  collection,  the  cost  of  advertising,  and  the  other  costs 
of  securing  business  as  well  as  in  the  elimination  of  lapses,  and  of 
the  necessity  for  accumulating  a  large  actuarial  reserve  in  invested 
funds.  The  advantages  are  similar  to  those  recently  realized  by 
insurance  companies  in  some  degree  and  on  a  small  scale  in  "group 


insurance." 


The  superintendent  of  insurance  of  the  District  of  Columbia 
reports  that  the  people  who  pay  health  insurance  premiums  to 
agents  who  collect  10,  15,  and  25  cents  a  week  at  the  homes  of 
policy  holders  "have  to  give  up  $1  for  every  40  cents  they  get 
back."  The  National  Convention  of  Insurance  Commissioners  in- 
their  examination  of  the  fourteen  principal  companies  writing  in- 
dustrial health  and  accident  insurance  found  that  the  ratio  of  losses 
showed  that  the  policy  holders  spent  $1  to  receive  back  a  benefit 
of  between  30  and  46  cents.  These  figures  are  in  striking  contrast 
to  the  results  of  the  compulsory  system  abroad ;  even  in  England 
where  the  cost  of  administration  is  high  because  of  the  supposed 
necessity  of  utilizing  preexisting  friendly  societies,  the  admini- 
strative cost  amounts  to  only  14  per  cent  of  the  income  of  the 
national  health  insurance  fund,  or  something  like  one-fourth  to 
one-third  the  cost  under  the  voluntary  system. 

Under  the  voluntary  system  the  policy  is  apt  to  lapse  just  when 
it  is  most  important  that  it  should  not.  The  Armstrong  investi- 
gating committee  in  New  York  (1906)  received  testimony  from 
one  of  the  largest  of  the  industrial  life  insurance  companies  to  the 
effect  that  one-third  of  the  policies  lapse  within  three  months,  one- 
half  within  a  year,  and  nearly  two-thirds  within  five  years!  Under 
the  compulsory  system  there  could  be  no  lapses. 

As  important  as  is  indemnification,  it  is  far  less  important  than 
prevention.  Almost  all  insurance  sooner  or  later  adds  the  function 
of  the  prevention  of  loss  to  that  of  indemnifying  against  loss.  Fire 
insurance  has  led  to  the  use  of  slow-burning  construction  and  other 
safeguards  against  destruction  by  fire.  Marine  insurance  has  led 
to  safety  at  sea.  Some  steam  boiler  insurance  companies  expend 
as  much  as  40  per  cent  of  their  income  in  inspection  and  other 
preventive  work.  Life  insurance  companies  are  now  instituting 
devices  for  extending  human  life. 

It  is  well  known  that  the  form  of  social  insurance  recently 
adopted  in  the  United  States,  namely  "workmen's  compensation," 
has  had   the  effect  of  greatly   stimulating   industrial  methods   in 


accident  prevention.  Out  of  workmen's  compensation  came  the 
"Safety  First!"  slogan  and  the  public  movement  which  it  repre- 
sents. J.  D.  Beck,  of  the  Wisconsin  Industrial  Commission,  de- 
clared that  more  progress  in  accident  prevention  had  been  made  in 
his  state  in  one  year  under  workmen's  compensation  than  in  any 
previous  period  of  five  years. 

The  importance  of  prevention  depends  in  any  individual  case 
on  the  degree  of  preventability,  and  in  the  case  of  human  morbidity 
the  degree  of  preventability  is  enormous.  Even  in  the  last  few 
years  there  have  been  opened  up  hitherto  undreamed  of  possibilities 
for  adding  to  life's  length,  vigor,  and  happiness. 

The  health  movement  can  be  far  more  potent  than  the  safety 
movement  because  sickness  is  more  prevalent  and  more  preventable 
than  accidents.  Pasteur  convinced  us  that  "It  is  within  the  power 
of  man  to  rid  himself  of  every  parasitic  disease,"  and  his  successor, 
Metchnikoff,  went  far  to  show  us  that  the  normal  life  span,  the 
Utopian  ideal  for  future  generations,  is  much  beyond  the  century 
mark.  Without  looking  so  far  ahead  we  may,  I  think,  accept  as 
conservative  the  calculations  of  the  National  Conservation  Com- 
mission that  at  least  42  per  cent  of  the  deaths  now  occurring  in  the 
United  States  are  unnecessary,  or  that  over  630,000  lives  could  be 
saved  annually  by  applying  existing  and  known  methods  of  life 
saving,  which  would  add  at  least  fifteen  years  to  the  average  dura- 
tion of  human  life.  These  estimates  are  doubtless  over-conserva- 
tive, as  may  be  judged  from  the  data  of  the  Commission  on  Indus- 
trial Relations,  from  the  recent  health  surveys  of  the  Metropolitan 
Life  Insurance  Company,  and  from  other  evidence. 

After  some  fifteen  years'  study  of  the  preventability  of  sick- 
ness, I  am  convinced  that  the  great  virtue  of  health  insurance,  for 
decades,  perhaps  for  centuries  to  come,  will  lie  in  the  prevention 
of  illness.  It  has  already  achieved  considerable  life  saving  in  Ger- 
many, although  when  the  system  was  established  there  the  idea 
of  the  preventability  of  disease  was  in  its  infancy.  According  to 
Dr.  Zacher,  reputed  to  be  the  best  authority  on  health  insurance  in 
the  world,  twelve  years  were  added  to  the  worker's  life  span  during 
thirty  years  of  health  insurance.  We  may  properly  attribute  part, 
if  not  most  of  this  increase,  to  health  insurance.  This  prolongation 
of  life  is  at  the  rate  of  forty  years  a  century,  the  highest  rate  of 
increase  known  in  any  country  or  any  period  of  time. 

Health  insurance  will  afford  a  very  powerful  and  pervasive 
stimulus  to  employers,  employees,  and  public  men  to  take  fuller 
and  speedier  advantage  of  possible  health  saving  devices.  The 
standard  bill  of  the  Association  is  so  drawn  as  to  give  any  locality 

10 


and  any  trade  the  benefit  in  lower  contributions  of  any  reduction 
in  sickness  rates  which  may  be  achieved,  thus  creating  an  immediate 
financial  motive  to  reduce  illness. 

Just  as  employers  have  installed  safeguards  for  dangerous 
machinery  in  order  to  reduce  the  cost  of  workmen's  compensation, 
so  in  order  to  reduce  the  cost  of  health  insurance  they  will  supply, 
for  instance,  better  sanitation,  ventilation,  and  lighting,  more  physi- 
ological hours  of  labor,  and  fuller  consideration  for  the  special 
needs  of  employed  women  and  children.  In  localities  where  the 
employer  provides  tenements  for  his  workmen,  he  will  be  led  to 
study  and  improve  housing  conditions.  So-called  welfare  work 
will  be  made  more  effective  and  helpful.  Employers  will  collect 
facts  and  statistics  as  to  sickness,  analyze  them  and  apply  such 
corrections  as  the  facts  discovered  indicate.  Dr.  Rubinow  states 
that  a  large  corporation  after  introducing  health  insurance  tried, 
for  the  first  time,  to  discover  its  sickness  rate  and  found  it  to  be 
three  times  what  is  usual.  Further  investigation  showed  that  this 
excessive  rate  was  due  to  bad  conditions,  not  in  the  factory,  but 
in  the  sanitation  of  the  city.  As  a  consequence  an  effort  was  made 
for  the  first  time  toward  improving  these  conditions.  It  is  especially 
to  be  expected  that  as  soon  as  employers  realize  the  nerve  strain 
caused  by  over-long  hours  and  consequent  increase  of  illness  and, 
therefore,  the  cost  to  themselves,  they  will  acquaint  themselves 
with  the  efifects  of  long  hours  of  labor  and  reduce  them. 

The  employee,  on  the  other  hand,  will  be  likewise  stimulated 
to  welcome  and  to  utilize  factory  hygiene,  and  improve  his  own 
domestic  hygiene  and  individual  hygiene.  If  there  could  be  any 
doubt  as  to  the  reality  or  strength  of  this  impulse  it  would  vanish 
after  observing  the  experience  in  Connecticut  of  the  employees' 
relief  associations  organized  to  combat  tuberculosis.  Each  work- 
man contributes  at  least  25  cents  and,  as  a  consequence  of  that 
investment,  takes  a  surprising  interest  in  seeing  that  his  money  is 
wisely  expended  and  that  tuberculosis  cases  are  promptly  discovered 
and  sent  away  for  treatment.  The  possibilities  of  self-improvement 
through  learning  how  to  live  are  far  beyond  what  any  one  who 
has  not  gone  over  the  evidence  realizes.  The  evils  of  bad  air,  bad 
food,  imperfect  teeth,  wrong  posture,  improper  clothing,  constipa- 
tion, self -drugging,  alcoholism,  etc.,  are  now  overlooked  by  ninety- 
nine  workmen  out  of  a  hundred.  Here  is  a  wonderful  opportunity 
for  effective  and  intelligent  leadership  among  committees  of  wage- 
earners.  The  employee  will  be  more  ready  to  apply  to  his  own 
internal  machinery  a  principle,  long  since  applied  by  his  employer 
to  inanimate  machinery,  the  principle  of  inspection   and  repairs. 

11 


After  health   insurance   has  been   adopted   slight   impairments   to 
health  will  be  remedied  before  they  become  serious. 

At  present  we  find  the  United  States,  in  striking  contrast  to 
health  insured  Europe,  is  suffering  from  an  increase  of  the  death 
rate  after  middle  life.  The  increase  consists  of  an  increase  in 
degenerative  or  wear-and-tear  diseases,  and  is  due  to  the  growing 
neglect  of  personal  and  other  hygiene.  The  death  rate  from  degen- 
erative diseases  in  the  United  States  registration  area  has  increased 
41  per  cent  in  twenty  years. 

One  important  effect  of  such  attention  to  the  health  of  the 
workman  will  be  the  prolongation  of  his  life  and  especially  of 
its  earning  period.  Fewer  workingmen  will  be  thrown  on  the 
scrap  heap  in  their  forties  with  all  the  tragic  consequences  involved 
to  their  families  as  well  as  to  themselves. 

Moreover,  the  cash  benefit  gives  the  workman  a  better  chance 
for  recovery  as  well  as  a  more  perfect  recovery  if  attained;  for,  to 
the  poor,  the  obstacles  to  recovery  are  largely  economic — insufficient 
food  or  other  necessaries,  worry  over  making  both  ends  meet, 
and  the  consequent  necessity  of  a  premature  return  to  work  while 
still  half-sick.  It  is  found  that  the  longer  the  time  given  up  to 
sickness,  which  means  the  more  care  given  to  get  well,  the  lower 
the  death  rate.  Critics  of  German  insurance  have  pointed  to  the 
fact  that  the  number  of  days'  absence  from  work  per  person  on 
account  of  illness  has  increased  under  health  insurance,  but  as 
Dr.  Rubinow  points  out,  this  increase  is  partly,  if  not  wholly,  due 
to  improved  and  longer  care  of  the  sick.  Only  part,  and  probably 
a  small  part,  can  be  charged  up  to  malingering. 

Again,  under  compulsory  health  insurance  both  employer  and 
employee  will  cooperate  with  the  general  public  in  securing  public 
water  supply,  better  sewerage  systems,  better  milk,  meat,  and  food 
laws,  better  school  hygiene,  more  playgrounds  and  parks,  and  proper 
regulation  of  liquor  and  other  health  destroying  businesses. 

Health  insurance  will  also,  as  it  did  in  Germany,  help  to  meet 
the  crying  need  for  rural  sanitation  and  bring  adequate  medical  and 
housing  care  to  American  farmers  and  their  families. 

Health  insurance  will  operate,  as  it  did  in  Germany,  to  stimu- 
late the  general  scientific  study  of  disease  prevention,  the  future 
possibilities  of  which  though  unknown  are,  we  may  be  sure,  enorm- 
ous. A  German  observer  states  that  social  insurance  led  to  new 
knowledge  in  the  field  of  occupational  diseases,  epidemics,  and 
accidents.  Dr.  Lee  K.  Frankel,  now  of  the  Metropolitan  Life  In- 
surance Company,  said  at  one  time  that  "German  insurance  legis- 

12 


lation  has  been  effective  in  producing  a  comprehensive  industrial 
hygiene."     Dr.  Bielefeldt,  quoted  by  Frederick  L.  Hoffman,  says: 

The  conviction  may  be  expressed,  after  the  experience  of  several 
years,  that  an  effective  battle  against  consumption  among  the  working 
classes  would  have  been  all  but  impossible  without  the  workmen's 
insurance  of  the  German  empire,  and,  by  the  support  of  their  powerful 
pecuniary  resources  and  with  the  aid  of  national  social  regulations,  in  the 
end  we  are  quite  certain  to  be  victorious. 

In  Great  Britain  the  health  insurance  act  has  led  to  education 
on  the  prevention  and  treatment  of  tuberculosis,  many  of  the  insur- 
ance committees  having  arranged  for  lectures,  \moving  picture 
shows,  and  other  means  of  educating  the  public. 

I  venture  to  predict  that  medical  and  hygienic  discoveries  and 
applications  will  be  far  more  rapid  in  the  future  than  in  the  past. 
What  directions  these  discoveries  will  take  can  only  be  guessed. 
I  expect,  however,  that  a  new  field  will  be  found  in  what  may  be 
termed  industrial  psychiatry,  the  development  of  which  will  not 
only  diminish  definite  diseases  but  will  also  diminish  industrial 
discontent  and  give  back  to  the  workman  what  the  economic  division 
of  labor  has  taken  away  from  him — a  real  interest  in  his  work. 
The  studies  of  a  few  of  us  in  economics,  particularly  Professor 
Carl  Parker  of  the  University  of  California,  and  a  few  in  industry, 
particularly  Mr.  Robert  B.  Wolf  of  the  Burgess  Sulphite  Fiber 
Company  of  Berlin,  New  Hampshire,  have  led  to  the  conclusion  that 
a  fundamental,  perhaps  the  fundamental,  cause  of  industrial  unrest 
is  to  be  found  in  the  fact  that  most  workers  at  present  cannot  in 
their  daily  tasks  satisfy  the  fundamental  human  instinct  of  work- 
manship. At  present  many,  if  not  most,  workmen  are  interested 
only  in  their  pay  envelopes.  I  anticipate  that,  within  a  few  years, 
under  proper  stimulus,  psychiatrists  will  be  able  to  show  employers 
how  to  make  jobs  interesting,  through  a  system  which  enables 
the  workman  to  understand  and  keep  a  record  of  the  results  of 
his  efforts  and  to  receive  credit  for  them  in  the  eyes  of  his  fellow 
workers,  his  employer,  and  himself.  What  little  experience  is  as 
yet  available  points  to  the  conclusion  that  devices  for  securing  a 
genuine  enthusiasm  for  the  job  mean  much  more  than  any  system 
of  scientific  management  for  the  health  and  happiness  of  the  em- 
ployee, for  industry,  and  for  industrial  peace. 

Besides  health  insurance  many  other  stimuli  of  course  exist, 
but  they  need  reenforcement.  Moreover,  nothing  can  equal  health 
insurance  as  a  stimulus  to  prevention  among  employers  and  em- 
ployees. 

13  . 


But  prevention  of  disease  and  disability  is  not  the  only  pre- 
vention to  be  effected  by  health  insurance.  It  will  indirectly  but 
powerfully  tend  to  reduce  poverty.  In  the  first  place  the  simple 
operation  of  the  indemnity  principle  itself  tends  to  reduce  poverty. 
F*overty  to-day  is  largely  mischance.  When  a  poor  man  becomes 
sick,  unless  he  can  tide  the  emergency  over  by  insurance  or  other- 
wise, he  runs  the  risk  of  getting  "down  and  out,"  for  he  has  little 
or  no  margin.  Without  health  insurance  a  vast  number  sooner  or 
later  exhaust  whatever  margin  they  have  and  sink  into  poverty — 
a  land  from  whose  bourne  few  travellers  return.  Students  of 
gambling  condemn  games  of  chance  because  sooner  or  later  most 
gamblers  must  lose  enough  to  throw  them  out  of  the  game.  At 
present  the  American  workmen  without  health  insurance  are  gam- 
bling with  their  livelihood  and  in  millions  of  cases  are  sure  to  be 
thrown  out  of  the  game.  It  is  not  a  question  of  average  well-being 
but  of  the  numbers  diverging  from  the  average.  One  opponent  of 
health  insurance  says  it  is  not  needed  in  America  because  the  "aver- 
age" American  workman  is  comfortably  situated.  Aside  from  the 
fact  that  the  most  comfortably  situated  workman  needs  health 
msurance,  we  must  not  forget  that  the  majority  of  workmen  have 
less  than  the  average  wages  and  that  a  large  minority  have  more 
than  the  average  sickness  (of  a  little  over  a  week)  per  year.  It 
is  true  that  American  wages  are,  on  the  average,  much  higher  than 
German  wages,  but  poverty  is,  or  was  before  the  war,  markedly 
less  in  Germany  than  in  the  United  States.  This  is  doubtless 
largely  if  not  chiefly  owing  to  health  insurance.  The  German 
laborer  has  not  been  allowed  to  gamble  with  disease  and  let  it  often 
win  away  from  him  his  little  all.  In  America,  where  the  working- 
man  is  not  so  protected,  we  see  the  results  in  the  casual  laborer. 
Warren  and  Sydenstricker's  Health  Insurance,  already  referred  to, 
states : 

The  casual  laborers  at  the  docks  in  New  York  City  are  composed 
largely  of  workers  who  have  gradually  lost  their  economic  status  in 
industry,  and  the  dock  worker  continues  to  slip  down  in  the  industrial 
scale  until  he  reaches  the  class  of  "shenagoes,"  the  down-and-out  long- 
shoremen who  are  capable  of  only  light  work  and  who  finally  become 
burdens  upon  public  and  private  charity.  According  to  testimony  before 
the  United  States  Commission  on  Industrial  Relations,  most  of  the  7,000 
applicants  for  work  at  the  San  Francisco  Cooperative  Employment 
Bureau  were  of  the  casual  labor  class,  and  one-half  of  the  total  number 
of  applicants  were  found  to  be  incapacitated  for  work  on  account  of  poor 
nutrition,  disease  and  exposure.  The  records  of  many  investigators  of 
the  unemployed  abound  with  similar  instances. 

14 


Frederick  Almy  states : 

In  Buffalo  sickness  is  more  serious  in  our  work  for  the  poor  than 
anything  else.  It  far  exceeds  unemployment  as  a  cause  of  poverty. 
Last  winter,  1914-1915,  for  instance,  when  the  industrial  depression  was 
so  high,  we  paid  out  $13,646  on  account  of  unemployment,  and  $29,275, 
or  more  than  twice  as  much,  to  families  in  which  there  had  been  sickness 
during  the  year. 

Again,  the  Charity  Organization  Society  of  Buffalo  reported  in 
1916  that  "Last  year  in  Buffalo  less  than  1  per  cent  of  our  poverty 
was  due  to  lack  of  work,  and  more  than  76  per  cent  to  sickness." 
According  to  an  officer  of  the  United  States  Public  Health  Service, 
assigned  to  the  Commission  on  Industrial  Relations,  sickness  pro- 
duces seven  times  as  much  destitution  as  industrial  accidents.  Dr. 
Devine  found  among  5,000  families  known  to  the  Charity  Organiza- 
tion Society  that  in  75  per  cent  illness  was  a  part  cause  of  poverty. 
The  report  of  the  Immigration  Commission  of  1909  states  that  "The 
illness  of  the  breadwinner  or  other  members  of  the  family  was  'the 
apparent  cause  of  need'  in  38.3  per  cent  of  the  cases,  while  accidents 
were  a  factor  in  but  3.8  per  cent  of  the  total  applications  for  aid." 
"At  the  New  York  legislative  hearing  on  the  health  insurance  bill  in 
1916  it  was  shown  that  37  per  cent  of  the  families  assisted  by  the 
New  York  Charity  Organization  Society  are  dependent  because  their 
wage-earners  are  disabled  by  sickness,  while  two-thirds  to  four- 
fifths  of  the  expenditure  of  the  New  York  Association  for  Improv- 
ing the  Condition  of  the  Poor  is  for  relief  necessary  because  of  ill- 
ness." In  the  report  of  the  New  York  Factory  Investigating  Com- 
mission (1915),  one  working  woman  gives  it  as  her  experience  that 
"practically  every  week,  in  her  factory,  there  is  either  a  collection  or 
raffle  for  the  benefit  of  some  worker  who  is  sick,  who  has  no 
resources,  and  who  therefore  is  an  object  of  the  charity  of  her 
fellow  employees."  This  custom,  states  the  report,  is  really  of  con- 
siderable significance  as  an  indication  of  how  few  are  able  to  accumu- 
late for  times  of  emergency.  It  is  also  significant  in  showing  how 
dire  is  the  need  of  health  insurance ;  for  raffles  and  the  like  are  a 
sort  of  stop-gap  or  make-shift  for  health  insurance. 

We  see,  then,  that  the  claim  that  in  America  we  do  not  need 
health  insurance  because  the  workman  is  so  well-to-do  is  very 
evidently  not  in  accord  with  the  facts.  As  the  Brief  for  Health 
Insurance  of  the  American  Association  for  Labor  Legislation  says, 
and  as  the  above  statistics  would  indicate,  "America  evidently 
presents  no  exception  to  the  finding  of  Mr.  and  Mrs.  Sidney  Webb, 
that  Tn  all  countries,  at  all  ages,  it  is  sickness  to  which  the  greatest 
bulk  of  destitution  is  immediately  due.' " 

15 


Aside  from  the  reduction  of  destitution,  health  insurance  will 
tend  to  raise  slightly  the  entire  wage  level.  As  Professor  Moore  of 
Columbia  has  shown  in  his  Lazvs  of  Wages  the  wage  level  is  funda- 
mentally influenced  by  industrial  productivity.  Anything  which 
raises  the  physical  stamina  of  workmen  increases  their  productivity 
and  earning  power.  Thus  the  victims  of  hookworm  disease  in  the 
South  are  poor,  and  constitute  the  "poor  whites"  because  they  are  | 
afflicted  with  the  "germ  of  laziness,"  their  power  and  inclination  to 
work  are  crippled.  The  Life  Extension  Institute  found  that  out 
of  2,000  workingmen  and  women  over  99  per  cent  were  below  their 
normal  working  power,  i.  e.,  were  suffering  from  some  condition 
or  habit  which  subtracted  from  their  efficiency.  These  minor 
impairments  of  health  and  efficiency  are  mostly  preventable,  and,  in 
fact,  in  the  group  referred  to,  were  in  part  prevented  through  the 
suggestions  of  the  institute  to  the  workingmen  themselves. 

Finally,  we  may  expect  health  insurance  to  help  forward  indus- 
trial peace,  for  it  will  create  machinery  for  continual  conference 
between  employers  and  employees. 

We  conclude  that  health  insurance  is  needed  in  the  United 
States  in  order  to  tide  the  workers  over  the  grave  emergencies 
incident  to  illness  as  well  as  in  order  to  reduce  illness  itself,  lengthen 
life,  abate  poverty,  improve  working  power,  raise  the  wage  level, 
and  diminish  the  causes  of  industrial  discontent.  It  is  not  a  panacea. 
It  will  not  bring  the  millennium.  But  there  is  no  other  measure 
now  before  the  public  which  equals  the  power  of  health  insurance 
toward  social  regeneration. 


16 


h 


THE  PUBLIC  HEALTH  MOVEMENT 

IRVING  FISHER 


"he  conservation  movement  is  a  movement  to 
vent  waste,  When  the  Conservation  Commis- 
n  was  appointed  four  years  ago,  emphasis  was 
ced   on   the   wastes  of   our  natural   resources, 

l)y  the  time  the  commission  made  its  report 
lad  come  to  the  conchision  that  by  "far  the 
st  serious  as  well  as  the  most  preventable 
stes  are  the  wastes  of  human  life. 

generation  ago  it  was  a  common  impression 

t  the  average  human  lifetime  was  fixed  as  by 

ecree  of  fate.     When  I  was  in  college  one  of 

revered    instructors   showed   us   a   mortality 

e,  and  said  with  great  impressiveness:  "There 
no  law  more  hard  and  fast  than  the  4aw  of 
rtality."    I  believed  it,  and-  even  yet  many  peo- 

are  under  this  delusion.  Pasteur  did  much 
introdrce  a  more  optimistic  view.     He  stated 

belief  in  these  immortal  words,  "It  is  within 

power  of  man  to  rid  himself  of  every  para- 
c  disease."    He  staked  this  opinion  on  his  own 

derful  laboratory  revelations  as  to  germ  life. 

ay  we  can  confirm  his  words  by  absolute 
istics.     And  now  his  successor,  Metchnikofif, 

surpassed  even  Pasteur  in  optimism.  Metch- 
jfF  is  devoting  himself  to  the  prolongation  of 
lan  life,  and  already  gives  us  a  vision  of  the 
p  „.i-.^«  ^.i.^f^nnt-Jni-jc;  y^,\\]  \^Q  Tegardcd  merely 

V  of  life,  and  when  the  normo: 

sp.i..  ui  <i  .  ..ntury  and  a  quarter  "•  ■'  '■■?■  -  f-  > 
]\  L»Ccuiierri;e. 

he  growing  consciousness  that  human  life  is 

a  fixed  allotment,  which  we  must  accept  as 

doom,   but   a   variable,   which   is  within   our 

^er  to  control,  has  recently  led  to  extraordi- 

r  exertions  all  over  the  world  to  save  human 

This  impulse  has  gained  strength  also  from 
great  and  almost  universal  decline  in  the 
h  rate.  Old  countries  like  France  and  new 
ntries  like  Australia  are  confronted  with  the 
ter  wof  depopulation.  Consequently,  as  hu- 
1  life  becomes  scarce,  it  becomes  precious — 
any  other  commodity !  These  two  facts,  the 
3ciousness  that  much  mortality  is  preventable, 
at  any  rate,  postponable,  and  the  fact  that 
easingly  fewer  babies  are  being  born  in  the 
Id,  are  together  operating  to  produce  a  great 
',th  movement  throughout  the  world.  Noth- 
will  stop  it  until  the  whole  world  is  convinced 
he  paramount  importance  of  this  problem  of 
lan  conservation. 

his  world-wide  movement  for  the  conserva- 
of  human  life  has  expressed  itself  in  many 
s — in  medical  research ;  in  societies  for  pre- 
ing  tuberculosis,  infant  mortality,  social  dis- 
5r  alcoholism,  and  vice;  in  the  growth  of 
toria.  dispensaries,  hospitals  and  other  insti- 
>'xc  ■,  i'.!.  g.f.  v-v.-nvense  output  of  hygienic  litera- 
.  not  only  tec'.inical  books  and  journals,  but 

popular  article  in  the  magazines  and  daily 
spapers;  in  the  di^istant  agitation  and  legis- 
)n  for  purer  foods,  milk  supply,  meat  supply 

1^  water  supply;  in  the  movement  to  limit  the 
r   of   women    and    children    and    to    improve 


factory  sanitation;  in  the  establishment  of  social 
insurance  in  Germany,  England,  Denmark  and 
other  countries;  in  the  improvement  of  Depart- 
ments of  Health;  in  the  spread  of  gymnastics, 
physical  training  and  school  hygiene;  in  the  re- 
vival of  the  Olympic  games  and  the  effort  to 
revive  the  old  Greek  ideals  of  physical  perfec- 
tion and  beauty,  and  last  and  most  important,  in 
the  sudden  development  of  the  science  of  eu- 
genics. 

In  the  summer  of  1911  there  was  held  in  Dres- 
den a  unique  world's  fair,  devoted  exclusively 
to  health — the  International  Hygiene  Exhibition. 
In  this  were  shown  the  fruits  of  the  v/hole 
movement  in  all  lands — except,  alas,  our  own ; 
for  to  our  shame  it  must  be  said  that  we  as  yet 
are  among  the  backward  nations  in  this  move- 
ment for  the  conservation  of  human  life.  Our 
Congress  was  asked  to  appropriate  $60,000  to 
erect  a  building  and  supply  an  exhibit  to  show 
what  we  have  done  for  our  part  in  this  move- 
ment, but  Congress  thought  it  could  not  afford 
so  large  an  expenditure  for  so  small  (!)  an  ob- 
ject, and  the  result  was  that  from  the  millions 
of  people  who  visited  this  exhibition  one  con- 
stantly heard  the  question  asked:  "Where  is  the 
United  States?" 

And  those  few  .Americans  who  did  go  to  visit 
the  exhibition  foi;nd  that  o^h^T  rntloas  ■  ' 
outstripped  us  in  this  movement  for  i..  ,,.. 
sanitation  and  health.  Some  of  the  achievements 
already  attained  by  Oiiicr  nations  should  be  re- 
corded among  the  wonders  6f  the  world.  One 
is  the  striking  decline  of  the  death  rate  in  the 
city  of  London.  Within  two  decades  London's 
death  rate  has  virtually  been  cut  in  two.  and  is 
now  only  thirteen  per  thousand,  or  less  than  that 
of  most  cities  one-fiftieth  its  size. 

Probably,  however,  the  greatest  achievement 
of  any  country  is  that  of  Sweden,  where  the 
duration  of  life  is  the  longest,  the  mortality  the 
least,  and  the  improvements  the  most  general. 
There  alone  can  it  be  said  that  the  chances  of 
life  have  been  improved  for  all  ages  of  life.  In- 
fancy, middle  age  and  old  age  today  show  a 
lower  mortality  in  Sweden  than  in  times  past, 
while  in  other  countries,  including  the  United 
States,  although  we  can  boast  of  some  reduction 
in  infant  mortality,  the  mortality  after  middle 
age  is  growing  worse,  and  the  innate  vitality 
of  the  people  is,  in  all  probability,  deteriorating. 
The  reason  why  Sweden  of  all  countries  has  suc- 
ceeded in  improving  the  vitality  of  middle  age 
and  old  age,  while  other  nations  have  failed,  is, 
I  believe,  to  be  found  in  the  fact  that  Sweden, 
of  all  nations,  has  seen  the  problem  of  human 
hygiene  as  a  whole  instead  of^partially.  In  most 
other  lands,  and  particularly  in  the  United  States, 
public  health  has  been  regarded  almost  exclus- 
ively as  a  matter  of  protection  against  germs; 
but  protection  against  germs,  while  effective  in 
defending  us  from  plague  and  other  epidemics 
of  acute  diseases,  is  almost  pdwerless  to  prevent 

I  1 


the  chronic  diseases  of  middle  and  late  life. 
These  maladies — Bright's  disease,  heart  disease, 
nervous  breakdowns — are  due  primarily  to  un- 
hygienic personal  habits.  Medical  inspection 
and  instruction  in  schools,  as  well  as  Swedish 
gymnastics,  have  aided  greatly  in  the  muscular 
development  of  the  citizens  of  Sweden.  Swed- 
ish hard  bread  has  preserved  their  teeth.  The 
Gothenburg  system  is  gradually  weaning  them 
from  alcohol.  There  has  even  been  a  strong 
movement  against  the  use  of  tobacco.  Other 
countries  are  tardily  following  in  the  path  which 
Sweden  has  trod  so  successfully. 

The  significant  fact  is  that  Sweden  has  not 
hesitated  to  attack  the  problem  of  personal 
habits.  I  believe  we  must  have  a  revolution  in 
the  habits  of  living  in  the  community  if  we 
are  going  really  to  realize  the  promise  of  ATetch- 
nikoff  and  others  as  to  the  prolongation  of  human 
life.  Health  officers  in  this  country  have  not  re- 
garded it  as  a  part  of  their  duty  either  to  live 
personally  a  clean,  hygienic  life,  or  to  teach  oth- 
ers to  do  so,  or  even  to  investigate  what  those 
conditions  of  well  being  are  which  make  for 
personal  vitality. 

I  can  remember,  thirteen  years  ago,  talking 
with  a  doctor  in  Colorado  as  to  the  habits  of 
living  of  his  patients.  I  said  to  him:  "You  tell 
me  that  tuberculosis  is  a  house  disease,  and  that 
the  reason  it  exists  is  because  people  do  not  open 
their  windows.  Why,  then,  do  you  not  tell  your 
Datients  they  most  open  tlieir  windows,  or  sleep 
'Ut  of  doors?"'  Bfi  said,  "I  wouldn't  dare  to 
d'j  that;  I  would  loJ5e  my  practice.  They  would 
think  I  was  a  cran'|,  and  meddling  in  their  per- 
-onal  alTairs."  Tt)day  that  battle  has  been 
largely  won.  Today,  not  only  in  Colorado  and 
California  and  in  the  places  where  there  is  per- 
petual sunshine,  sleeping  out  of  doors  is  com- 
innii  and  not  confined  to  invalids,  but  is  indulged 
in  by  the  community  generally.  Even  in  New  Eng- 
land and  throughout  the  country  you  will  find 
sleeping  balconies  going  up  all  over.  The  change 
has  even  affected  in  some  degree  the  architecture 
of  the  country,  and  while  as  yet  only  a  minority 
of  the  people  sleep  out  of  doors,  yet  T  believe  it 
is  true  that  the  majority  of  the  people  in  the 
United  States  have  far  more  air  in  their  sleeping 
and  living  rooms  today  than  ten  years  ago.  The 
fact  which  the  doctor  in  Colorado  did  not  dare 
tell  his  patients  thirteen  years  ago  has  in  some 
way  been  told  to  the  people  of  the  United  States. 

But  there  are  many  other  things  that  need  to 
be  told,  after  we  are  sure  that  they  are  true. 
When  we  have,  through  our  national,  state  or 
municipal  officers,  made  thorough  investigations 
and  have  been  able  to  discover  the  actual  truth 
as  regards  eating  and  drinking,  hours  of  Vork, 
recreation  and  play — all  those  facts  that  go  into 
what  may  be  called  personal  habits — then  we  may 
gradually  overturn  existing  unhygienic  habits  of 
livmg.  John  Burrs  attributes  a  large  part  of 
the  great  reduction  in  London  mortality  to  the 
improved  personal  habits  of  working  men,  par- 
ticularly -in  regard  to  alcohol.  In  this  country 
Dr.  Evans,  both  as  [health  officer  of  Chicag-o  and 


later  as  health   edi 
has   shown    how    p 


or  of  a   Chicago  newspaper, 
pblic    instruction    in    personal 


habits  can  be  made  effective,  and  it  will  t 
largely  through  affecting  personal  habits  that  ti- 
ll fe  insurance  companies  will  improve  the  longe\ 
ity  of  their  policy-holders. 

Scientific  men  today  have  reached  substanti; 
agreement  that  alcohol  is  a  poison.  When  ever; 
body  understands  this,  the  days  of  alcohol  as 
beverage  will  be  numbered.  Sweden  in  the  30 
was  called  drunken  Sweden,  but  today  the  am 
alcohol  jnovemcnt  there  has  converted  Swed( 
into  one  of  the  soberest  of  countries. 

But  the  use  of  tobacco,  tea  and  coffee  ougl 
also  to  be  investigated,  so  that  we  may  kno 
how  far  they  are  deleterious,  and  to  spread  tb 
knowledge  among  the  people. 

Eashions  are  in  their  essence  changeable,  ar 
the  time  will  come  when  the  world  will  not  I 
built  on  fashion,  but  on  reason.  Japan  has  mac 
more  rapid  progress  in  civilization  than  ai 
other  nation — because  the  late  Mikado  resolvf 
and  publicly  stated  that  the  institutions  of  Jap; 
must  not  be  tied  by  tradition,  but  nmst  be  bas< 
on  reason.  When  we  have  replaced  traditic 
by  reason,  we  shall  have  gotten  a  solid  basis  fij 
civilization,  and  this  must  apply  to  ancient  cu| 
toms  and  habits  of  every  kind.  I  am  firmly  co 
vinced  that  we  are  looking  at  only  one-half  > 
this  public  health  movement  as  long  as  we  co 
fine  ourselves  to  the  acute  or  infectious  di 
eases.  We  shall  not  get  more  than  half  the  r 
suits  obtainable  until  we  realize  that  there  mv 
be  a  revolution  in  the  pci':  '  habits  ;.  V 
people. 

Yet  the  United  States,  in  spite  of  its  shortcoi 
ings,  has  some  special  triumphs  to  record.  V 
have,  through  hygiene  under  Colonel  (nirg.' 
made  it  possible  to  dig  the  Panama  Canal.  V 
have  virtually  abolished  yellow  fever  on  o 
shores  and  in  Cuba.  We  have  nearly  eliminat 
hookworm  disease  in  Porto  Rico  and  are  grad 
ally  doing  the  same  in  the  southern  states.  V 
have  found  a  remedy  for  one  fonn  of  spin 
meningitis.  We  have,  in  New  York,  made  ; 
object  lesson  in  the  last  year  of  reducing  t 
summer  death  rate  of  infants  in  a  striking  ma 
ner.  We  have,  by  individual  milk  stations 
Boston  and  other  cities  and  in  individual  sati 
toria,  dispensaries  and  other  institutions,  denin 
strated  that  the  death  rate  from  specific  diseas 
can  often  be  cut  in  two.  '{ 

Yet  we  have  depended  altogether  too  much ! 
private    initiative.      In    New    York    the    sumfll 
death     rate     of     infants     was     reduced     chie 
through    the    work    of    the    milk    committee   a 
individuals   like   Nathan    Straus.     The  discoy^ 
of  the  wide  prevalence  of  hookworm  disease  Jjj 
the  discovery  of  the  scrum   for  spinal  meningi 
came  through   the  gifts  of   Mr.   Rockefeller, 
is  well  that  individuals  should  apply  themselti 
to  these  problems,  and  without  such  personal*! 
terest  they  could  never  be  solved.     Neverthele 
progress  will  be  many  times  as  rapfci   whenTl'li 
problems   for  the  nation   are  managed   in      {/id 
tional  way.     There  are   three  great   agen  :i  a^'a 
which  we  must  look  for  the  saving  of  human  '"I'Se 
in  the  future,  and  it  has  been  the  object  of  ^  tl 
Committee  of  One  Hundred  on  National  Het  '■■ 
of  which  I  am  president,  to  help  stir  these  th  in 

-■I 


sncies  into  activity  in  this  country.  They  are 
public  press,  the  insurance  companies  and 
government. 
To  a  limited  extent,  all  these  agencies  have  in- 
ased  their  health  activities  in  recent  years, 
few  years  ago  popular  articles  on  public 
ilth  were  seldom  seen^  because  the  i)ublic  and 
press  thought  the  subject  of  disease  unintcr- 
ing  and  repulsive.  Today,  on  the  other  hand, 
;  can  scarcely  pick  up  a  popular  magazine 
hout  finding  not  only  one,  but  several,  articles 
ling  with  questions  of  public  health;  and  it 
;  been  found  possible  not  only  to  make  these 
icles  interesting,  but,  by  emphasizing  the  posi- 
;  or  health  side,  instead  of  the  negative  or 
ease  side,  to  render  them  attractive  and  beau- 
il.  And  yet,  as  Dr.  Wiley  has  said,  the  nevvs- 
^ers.  in  spite  of  all  the  good  they  are  doing 
h  their  right  hands,  are,  with  their  left  hands, 
heir  advertising  columns  trying  to  undo  that 
)d  by  advertising  the  fraudulent  part  of  the 
aling"  profession  who  are  trying  to  line  their 
1  pockets  at  the  expense  of  the  lives  of  the 
•lie. 

he   second   great   agency   from   which,    I   be- 
e,   we   may   expect   wonderful   results   in   the 
ire  is  life  insurance.    As  our  committee  point- 
out  to  the  association  of  life  insurance  presi- 
Is  several  years  ago,  life  insurance  companies 
save  money  by  preventing  deaths  just  as  fire 
irance  companies  have  saved  money  by  pre- 
ting   fires,   ?.nd   steam   boiler  insurance   com- 
ies  have  saved  money  by  preventing  explo- 
IS.     Since  this  suggestion  was  "made,  a  num- 
oi  progressive  life  insurance  companies  have 
!  the  experiment.     The  Metropolitan  and  the 
itable  have  established  departmenis  of  human 
servation,  and  a  rwmber  of  other  and  smaller 
;ipanies   have   undertaken    similar   enterprises. 
?  Postal  Life  Insurance  Company  has  recently 
lished   the  statistical   results  of  their  experi- 
p,  worked  out  in  a  most  careful  manner,  and 
demonstrated  absolutely  that  it  pays  life  in- 
ance  companies  to  save  human  life     This  be- 
the  case,  we  may  expect  life  insurance  com- 
ies    in    the    future    to   become   active    in    life 
servation.      Already    there    are    probably    fif- 
million   policyholders   in   the  United   States 
ired    in    companies   which    are   trying   to   do 
ething  for  their  health — through  medical  ex- 
nations,  instruction   in  hygiene,  utilization  of 
ting    nurses,     participation     in     civic     health 
/ements  and  otherwise.     To  save  human  life 
ely  to  save  money  is  sordid  enough,  but  it  is 
tl  to  harness  commercial   motives,  when   pos- 
e.  in  the  service  of  humanity, 
he   third    and   most   important   agency   is   the 
lernment.      State    and    national    health    offices 
becoming  yearly  stronger  and  more  efiicient ; 
yet  much    remains   to  be   done,   particularly 
'.le  national  government.     We  need  a  national 
jartment   of  health   or  a   department   of  labor 
'Jch    shall    include    in    its    operations   the    con- 
;  jl /ation     of    human    life.      We    have    already 
',t(;ed  the  phosphorus  match  bill  to  prevent  one 
'j\{  the    worst    industrial    diseases — phossy    jaw. 
.:!     have   passed   effective   legislation    in    regard 
;'j  ntcrstate  commerce  in  prostitution.     We  have 


established  a  Children's  Bureau,  and  a  Bureau 
of  Mines  to  prevent  industrial  accidents  in  min- 
ing. We  have  enacted  suital)le  legislation  in  re- 
gard to  cocaine  and  habit-forming  drugs.  We 
have  a  Pure  Food  Law  and  laws  for  the  inspec- 
tion of- meats.  Yet,  as  Dr.  Wiley,  Mrs.  Crane 
and  others  who  have  watched  the  operation  of 
these  laws  at  close  range  well  know,  they  need 
-to  be  executed  with  a  stronger  hand. 

The  truth  is  that  as  yet  we  have  only  made  a 
feeble  beginning  in  public  health  work,  especially 
in  this  country.  We  need,  first  of  all,  to  do 
what  Sweden  has  done  for  a  hundred  and  fifty 
years — namely,  to  keep  proper  vital  statistics. 
Vital  statistics  are  the  bookkeeping  of  health, 
and  we  cannot  economize  health  any  more  suc- 
cessfully than  we  can  economize  money  unless 
we  keep  books.  At  present  only  a  little  over 
half  of  the  population  of  the  United  States  has 
statistics  of  its  deaths,  while  the  statistics  of  the 
births  are  as  yet  nowhere  sufficiently  accurate  to 
be  called  real  statistics. 

Our  national  statistician,  Dr.  Wilbur,  illus- 
trates by  a  story  how  much  better  we  keep  our 
commercial  books  than  our  books  of  vital  sta- 
tistics. In  a  western  state  a  girl  was  entitled  to 
a  fortune  when  she  became  twenty-one.  Reach- 
ing, as  she  supposed,  her  twenty-first  birthday, 
she  laid  claim  to  the  fortune.  Aluch  to  her  sur- 
prise, her  father  said:  "But  you  are  only  nine- 
teen"; and  then  the  two  tried  to  look  up  the 
records.  They  had  no  family  Bible,  they  had  no 
public  record  office  to' go  to,  "and  thev  were  at 
sea  as  to  how  to  discover  exactly  the  date  wher 
she  was  born.  However,  it  suddenlv  occurred 
to  her  father,  who  was  a  farmer,  that  on  the 
very  day  his  daughter  was  born  a  calf  was  born 
on  his  farm,  and  the  birth  of  the  calf  had  been 
recorded.  In  that  way  he  established  the  date  of 
the  birth  of  his  daughter. 

In  view  of  the  great  lack  of  our  vital  statis- 
tics, therefore,  we  cannot  measure  even  the  death 
rate,  much  less  the  number  of  preventable  deaths 
in  the  United  States.  All  that  we  can  do  is  to 
study  carefully  the  registration  area,  and  on  this 
basis  to  work  out  certain  minimum  figures. 

Four  years  ago,  as  a  member  of  President 
Roosevelt's  Conservation  Commission,  I  endeav- 
ored to  do  this  and  to  report  on  the  condition  of 
our  "national  vitality."  I  found,  after  getting 
together  all  the  statistics  available  and  taking 
account  .(^f  the  degree  of  preventability  of  dif- 
ferent diseases  as  estimated  by  experts,  that  out 
of  some  1,500,000  deaths  annually  in  the  United 
States  at  least  630,000  are  preventable !  Of  these 
preventable  deaths  the  greater  number  are  from 
seven  causes.  These  seven  causes  include  three 
great  diseases  of  infancy;  then  typhoid  fever, 
which  usually  makes  its  attack  in  the  twenties; 
then  tuberculosis,  accidents  in  industry,  and 
pneumonia,  which  come  in  the  thirties. 

Now  630,000  unnecessary,  deaths  per  ^.-oar- 
mean  over  1,700  unnecessary  deaths  per  day.  or 
more  than  the  lives  lost  in  tie  Titanic  disaster! 
The  nation  cannot  continue  inlifferent  to  hygiene 
as  it  gradually  dawns  on  the  public  that  for  lack 
of  hygiene  we  suffer  a  Titanic  disaster  every 
day  of  the  year.     The  popular  imagination  was 


deeply  stirred  by  the  image  of  1,600  helpless 
human  beings  suddenly  engulfed  in  midocean. 
That  was  a  vivid  dramatic  picture  which  the 
blindest  of  men  could  see  and  understand.  It 
led  to  immediate  oflicial  action  on  both  sides  of 
the  Atlantic  to  sai'eguard  human  life  at  sea. 
Yet  on  land  we  lose  365  times  as  many  lives  as 
this  every  year,  and  never  stop  to  add  it  up ! 
Ihoy  are  scattered  and  diffused  throughout  the 
land— a  Wilbur  Wright  lost  from  typhoid,  a 
handful  of  miners  in  an  explosion,  some  railway 
employes  in  an  accident,  some  victims  of  lead 
poisoning,  a  little  army  of  infants,  here  a  few 
men  and  there  a  few.  Yet  these  deaths  are  just 
as  real  and  mean  an  infinitely  more  serious  loss 
than  the  deaths  from  the  Titanic  disaster.  More- 
over, they  could  be  as  easily  prevented. 

And  concomitant  with  this  unnecessarily  great 
death  rate  there  is,  of  course,  a  colossal  aggre- 
gate of  needless  sickness.  We  have  no  real  sta- 
tistics, but  by  analogy  with  English  statistics  we 
may  assume  that,  on  the  average,  for  every  death 
per  annum  there  are  two  persons  sick  during  the 
year.  This  makes  about  3,000,000  people  con- 
stantly lying  on  sick  beds  in  the  United  States, 
of  which,  on  the  most  conservative  estimate,  at 
least  half  need  not  have  been  there. 

If,  now,  on  the  basis  of  these  figures,  we  try 
to  compute  how  much  human  life  is  needlessly 
shortened  in  the  Urited  States,  we  find  that  it  is 
shortened  at  least  fifteen  years.  Again,  if  we 
translate  these  preventable  losses  into  comri.ier- 
inl  terms,  we  find  (hat,  ev.n  by  the   most'  con- 

rvat've  reckoningi  this  country  is  losing,,  over 
-),uOO  woi't^   of  wealth-producing  power 
.vr.y  J  cat. 

What  does  this  inerr,"  To  us.  individually  it 
means  that  we  are  losing  a  large  part  of  our 
rightful  life  not  only  by  death  itself,  which  cuts 
ofif  many  years  we  might  have  lived,  but  also 
from  diseases  and  disabilities  which  are  not 
f.ital  but  cripple  the  power  to  work  and  mar  the 
joy  of  living.  I  believe  I  am  far  within  the  facts 
when  I  venture  the  opinion  that  the  average  man 
or  woman  in  the  U:iited  States  is  not  doing  half 
of  the  work  nor  having  half  of  the  joy  of  work 
of  which  the  humari  being  is  capable. 

With  all  this  room  for  improvement  before 
our  eyes,  it  is  not  surprising  that  the  zeal  of  the 
health  movement  is  growing  fast.  Each  success 
serves  as  justificatidn  for  further  effort. 

One  of  the  most  encouraging  symptoms  of 
progress  is  the  grekt  attention  which  was  paid 
to  public  health  in  the  recent  political  campaign. 
All  three  of  the  party  platforms  included  planks 
in  behalf  of  publi  health.  The  Democratic  and 
Progressive  platforms  were  particularlv  explicit 
and  emphatic,  and  all  the  candidates  have  em- 
phasized health  in  speeches  and  in  their  record 
in  public  life. 

'J  hese  and  other  |  indications  augur  well  for 
better  legislation,  m^re  energetic  enforcement  "of 
the  law  and,  above  all,  a  more  appreciative  pub- 
lic sentiment  as  to  the  transcendent  importance 
of   the  conservation  of  human  life.     It   is  now 


reported  that  Dr.  Roche,  secretary  of  state  ; 
Canada,  is  in  strong  sympathy  with  the  propos 
there  for  the  establishment  of  a  Federal  Dcpar 
ment  of  Health,  and  the  Republic  of  China 
reported  to  have  already  established  such  a  d 
partment. 

From  all  these  indications  of  actual   activit 
as   well   as   from   the   logic   of   the  situation,  v! 
are  justified  in  predicting  that  an  age  of  hum; 
conservation   is  at  hand.     Men  and   women  a 
waking  to  their  responsibility  to  the  race.     E 
genics  will  be   a  vyatchword  of  the   future.     '. 
squander    our    natural    resources    is    ignoble    i 
deed,  but   far  worse   is   it   to  squander  our  vit 
resources.     The  most  sacred  obligation  of  ea^l 
generation   is  to   bequeath   its   life  capital  unii 
paired    to    the    generation    which    comes    aft< 
Scourges   like  typhoid   and   tuberculosis   must 
swei)t  oft"  the  face  of  the  earth.     Haljit-formiii 
drugs,  including  alcohol  (and  even  tobacco,  esp 
cially    for  young   boys),   must    be   recognized 
their  true  light  as  means  of  depleting  the  viiali 
of    nations.      Prostitution    and    the    white    sla 
traffic   must   be   condenmed   anew   as   robbers 
the  race.     Industries  which  kill  and  maim,  pois< 
or  infect  their  workers,  which  deform  anrl  stu 
little  children,  which  incapacitate  women  for  ric 
mal  motherhood,  which   tlirough  overlong  hou 
of  toil  close  each  successive  day's  work  with  pr 
gressive    exhaustion,    must    be    controlled.      M 
chinery  was  made  for  man,  not  man  for  machi, 
ery.     Marriage   laws  and  customs  must  be  a 
justed  so  as  to  discourage  or  forbid  the  pr     • 
tion  by  the  unfit.     All  these  and  other  hv;  ;: 
and  eugenic  reforms  will  be  realized  as  i 
pul)rc  sentiment  beconv^-     rlucated  to  the  S'  !cn' 
responsibilities  and  higher  valuations  ot  hum 
life. 

The  noblest  task,  therefore,  which  I  can  co 
ceive  for  any  man  is  to  aid  in  erecting  true  ide? 
of  perfect  manhood  and  womanhood.  Our  idea 
though  improving,  are  not  yet  worthy  to  be  coi 
pared  with  those  of  Japan  or  Sweden,  and  t 
ideals  even  of  these  countries  have  not  j 
reached  the  level  of  those  of  ancient  Greece  si 
imaged  for  us  in  imperishable  marble.  With  s 
perior  knowledge,  our  health  ideals  should  ex( 
those  of  any  other  age.  These  ideals  should  n 
stop  with  the  mere  negation  of  disease,  dege 
eracy,  delinquency  and  dependency.  They  shot 
be  positive  and  progressive.  They  should  inclu 
muscular  development,  a  sound  mind  in  a  sou 
body,  integrity  of  moral  fiber,  a  sense  of  t 
splendor  of  the  perfect  human  body  as  a  tem( 
of  the  human  soul,  a  sense  of  the  enjoyment 
all  life's  proper  functions.  As  William  Jam 
said,  simply  to  breathe  or  move  our  muse" 
should  be  a  delight.  The  thoroughly  healt 
person  is  full  of  joy  and  optimism.  He  rejoice 
like  a  strong  man  to  run  a  race.  Said  Emerso 
"Give  me  health  and  a  day,  and  I  will  make** 
pomp  of  emperors  ridiculous!"  Our  health  ide 
should  be  nothing  short  of  an  abidmg  "sense" 
the  sweetness  and  beauty,  the  nobility  an]  ' 
ness  of  human  life. 


/ 


/ 


THE   "RATIO"   CHART 

For  Plotting  Statistics 


By 


p  PROFESSOR  IRVING  FISHER 

Yale  University 


[Reprinted  from  Quarterly  Publications  of  the  American  Statistical 

Association,  June,  1917.] 


13]  The  ''Ratio"  Chart.  577 

THE   "RATIO"   CHART 

For  Plotting  Statistics. 

By  Professor  Irving  Fisher,  Yale  University. 


COMPARING    TWO    MAGNITUDES    BY   THEIR   DIFFERENCE   AND    BY 
'  THEIR   RATIO. 

In  the  last  few  years  there  has  been  a  great  increase  in  the 
appreciation  and  use  of  statistical  charts.  As  a  consequence, 
a  number  of  efforts  have  been  made  to  improve  the  technique 
of  graphic  representation  in  order  that  the  chart  may  convey 
its  message  more  quickly,  accurately,  and  unmistakably. 
Toward  this  end  Mr.  Willard  C.  Brinton  in  particular  has  put 
us  all  under  obligation.* 

In  the  present  article,  I  shall  describe  the  nature  and  ad- 
vantages of  one  form  of  chart  on  which  to  plot  a  statistical 
curve, — by  which  is  meant  any  curve  or  broken  line  showing 
the  different  numerical  values  of  a  statistical  magnitude  at 
different  periods  of  time.  This  chart  will  be  found  of  very 
great  assistance  when  the  only  object  or  the  chief  object  is  to 
display  and  compare  ratios.  It  may  therefore  be  called  the 
"ratio"  chart. t 

The  chief  reason  why  ratio  charting  has  not  yet  been  more 
widely  used  is,  I  believe,  that  its  extreme  simplicity  is  not  yet 
realized.  Those  who  have  mentioned  it  in  print  have  usually 
contented  themselves  with  stating  dogmatically  how  it  is  to 
be  used  without  explaining  the  whys  and  wherefores,  further 
than  that  its  spacing  is  "  logarithmic  "  like  that  of  a  log- 
arithmic slide  rule.  But  most  persons  regard  logarithms  and 
slide  rules  as  a  species  of  magic  and  fight  shy  of  a  method,  the 
foundations  of  which  they  do  not  clearly  understand. 

•Through  the  publication  of  his  "Graphic  Methods  for  Presenting  Facts,"  New  York  (The  Engineering 
Magazine  Company),  1914,  371  pp.,  and  through  the  worlj  of  the  Joint  Committee  on  Standards  for 
Graphic  Representation  which  grew  out  of  the  publication  of  his  book. 

tl  am  not,  as  I  originally  supposed,  the  first  to  hit  on  this  simple  device,  although  it  still  remains 
almost  wholly  unknown  and  unused  and  has  never  yet,  so  far  as  I  know,  been  adequately  described.  A 
bibliography  of  the  very  meagre  literature  on  the  subject  is  given  at  the  end  of  this  article.  It  is  there 
shown  that  the  method  in  essence  was  used  as  early  as  1863. 


578 


American  Statistical  Association. 


[14 


POP 

IN 

Mill. 


The  object  of  this  article  is  to  make  the  construction  of 
the  ratio  chart  clear  to  any  reader  and,  at  the  same  time,  to 
point  out  in  some  detail  its  various  uses  and  advantages.  In 
doing  this  it  is  quite  unnecessary  to  use  even  the  concept  of 

logarithms. 

We  may  compare  any  two 
magnitudes,  of  like  kind,  by 
means  either  of  their  differ- 
once  or  of  their  ratio.  In  the 
first  kind  of  comparison  "an 
inch  on  theendof  one'snose" 
is  exactly  as  much  as  an  inch 
added  to  the  height  of  the 
Washington  Monument;  in 
the  second  kind  of  compari- 
son, on  the  other  hand,  "an 
inch  on  the  end  of  one's  nose ' ' 
is  an  addition  of  about  40  per 
cent.,  or  as  much  as  220  feet 
added  to  the  height  of  the 
Monument. 

The  ordinary  chart  is  adap- 
ted to  difference  comparisons 
rather  than  to  ratio  compari- 
sons, whereas  the  statistician 
is  usually  concerned  with 
ratio  comparisons  far  more 
than  with  difference  compa- 
risons.  ' 


FIG.    Id.    FUTURE  HYPOTHETICAL    POPU- 
LATION OF  THE  UNITED    STATES.     OR 
DINARY  OR  DIFFERENCE  METHOD. 
Equal  vertical  intervals  represent  equal  statistical 

differences.    A  line  in  ascending  at  a  uniform  ratio  is 

curved.     Uniformity  is  therefore  not  evident  to  the 

eye. 


^  S 
•^  ^ 
^     ^ 


,^  ^  ^  £ 

lo  XJ  j^  ^ 

_,        <3,  O)  <^  0> 

N         S  <  N  \»' 


CONVERTING  ORDINARY 
PLOTTING    PAPER. 

Fig.  1  d  C'd"  standing  for 
"difference")  shows  an  ordi- 
nary plotting  chart;  that  is, 
a  chart  with  equal  vertical 
spacing,  labelled  for  popula- 
tion in  millions,  the  labelling 
being  for  equal  statistical  differences,  and  each  interval  of  verti- 


y£Aff^ 


FIG.    Ir.    THE  SAME.    RATIO  METHOD. 
The  same  assumption.    Uniformity  is  here  evident 
to  the  eye,  being  represented  by  a  straight  line. 


15]  The  ''Ratio''  Chart.  579 

cal  ascent  representing  an  increase  of  10  millions  over  the  pre- 
ceding. 

Since  the  key-idea  of  the  ratio  chart  is  that  equal  vertical 
intervals  represent  equal  ratios  of  increase  instead  of  equal 
differences  of  increase,  it  may  also  be  constructed  from  ordi- 
nary cross  ruled  plotting  paper.  This  may  be  done  in  two 
steps,  (1)  labelling  the  existing  lines  and  (2)  interpolating 
new  lines.  The  first  step  is  to  label  the  existing  (equidistant) 
horizontal  lines  with  numbers  increasing  in  a  given  ratio. 

Fig.  1  r  C'r"  standing  for  "ratio"),  shows  a  ratio  chart 
made  from  ordinary  ruled  paper  simply  by  labelling  the  hori- 
zontal lines  for  ratios,  each  interval  of  vertical  ascent  now  rep- 
resenting an  increase  of  10  per  cent,  over  the  preceding. 
That  is,  while  the  first  chart  is  labelled  vertically,  100,  110, 
120,  130,  140,  150,  160,  170,  180,  190,  200,  etc.  (each  number 
being  10  more  than  the  one  below)  the  second  chart  is  labelled 
vertically,  100,  110,  121,  133,  146,  161,  177,  195,  etc.*  (each 
number  being  10  per  cent,  more  than  the  one  below). 

The  ratio  method  consists  simply  in  plotting  any  statistical 
curve  by  using  the  labels f  of  Fig.  1  r  instead  of  those  of  Fig.  1  d. 

Thus,  let  us  plot,  say,  the  (imaginary)  population  of  the 
United  States  in  millions,  beginning  with  100  millions  in  1910 
and  assuming  an  increase  of  10  per  cent,  every  decade.  Since 
all  increases  of  10  per  cent,  are  represented  in  Fig.  1  r  by  equal 
vertical  distances,  it  is  clear  that  the  curve  representing  popu- 
lation, i.  e.,  connecting  the  series  of  points  in  Fig.  1  r  lying 
diagonally  on  the  cross  lines,  will  be  a  straight  line. 

Thus  we  see  the  first  merit  of  the  ratio  method  of  charting 
the  growth  of  a  statistical  magnitude:  uniformity  in  the  per- 
centage rate  of  growth  is  pictured  by  straightness  in  the  plotted 
line. 

On  the  other  hand,  in  the  ordinary  or  difference  chart,  such 
as  that  of  Fig.  1  d,  the  same  population  growth  will  be  repre- 
sented by  an  "exponential  curve"  and  its  uniformity  of  per- 

*If  we  carry  the  numbers  backward,  that  below  100  will  be  91  (for  91:100::10:11);  that  next  below  91 
will  be  83;  and  so  on,  indefinitely,  down  to  any  number,  however  small,  except  zero.  Evidently  we  caa 
approach  as  near  to  zero  as  we  please  but  zero  itself  recedes  into  a  bottomless  pit;  there  is  no  base  or  zero 
Hne. 

tOf  course  in  the  ratio  chart  as  in  the  difference  chart  the  numbering  may  be  magnified  or  reduced  id  any 
ratio.  Thus  instead  of  the  numbers  100,  110,  121,  etc.,  we  may  substitute  1.00,  1.10  1.21  or  .100,  .110, 
.121,  etc.,  etc. 


580 


Air^erican  Statistical  Association. 


[16 


centage  rate  of  growth  is  altogether  lost  to  the  eye.     In  fact 
the  uninitiated  are  apt  to  be  misled  and  to  falsely  infer  from 

such  a  curve  that  the 
rate  of  growth  is  in- 
creasing. 

RERULING  THE  RATIO 
CHART  SO  OBTAINED, 

But  the  ratio  chart, 
as  described  above,  is 
not    very   convenient 
for  plotting  points  be- 
tween the  ruled  lines, 
because  so  few  of  the 
labels  are  round  num- 
bers.    To  make  a  full 
fledged    ratio    chart, 
new   horizontal    lines 
need    to    be   interpo- 
lated, at  their  proper 
places,   corresponding 
to  the  round  numbers 
120,  130, 140,  150,  etc. 
(Fig.  2  r)  and  the  orig- 
inal equi-distant  ones 
should    be   erased.* 
The  contrast,  then,  be- 

*Plottmg  paper  for  ratio  charts 
may  now  be  obtained  ready-made 
from  a  few  commercial  firms,  the 
Educational  Exhibition  Company, 
26  Custom  House  Street,  Providence, 
R.  I.,  John  Wenzel,  63  West  107th 
Street,  New  York  City,  Keuffel  and 
Esser  Company,  127  Fulton  Street, 
New  York  City,  and  the  Standard 
Graph  Co.,  32  Union  Square,  New 
York  City. 

The  unequally  spaced  horizontal 
lines  shown  in  Fig.  2  r  become  more 
and  more  crowded  together  as  we 
ascend,  until  it  becomes  necessary,  or 
advisable,   to  omit  some  of   them. 

The  omission  of  these  lines  causes  the  plotting  paper  to  present   the  appearance  of  an  intermittent  or 

cyclical  spacing  (Fig.  3  r). 


FIG.  2d.  SHOWING  GEOMETRICAL  (A)  AND  ARITH- 
METICAL  (B)  PROGRESSIONS.  DIFFERENCE 
METHOD. 

A  line  (A)  ascending  ,at  a  uniform  ratio  in  equal  periods  of 
time,  that  is,  in  geometrical  progression  is  curved  (upward). 
A  line  (B)  ascending  by  equal  differences  in  equal  periods  of 
time,  that  is,  in  arithmetical  progression,  is  straight.  Note 
that  vertical  intervals  increasing  in  geometrical  progression 
(see  the  Ught  figures)  are  unequally  spaced. 


200— T 

t  y\ 

y 

/■ 

/ 

/ 

'^'^ 

/ 

y^ 

^lOi 

/ 

/ 

reo^2- 

/ 

/ 

/SO — 

/  / 

no 

■~ 

} 

/ 

/40— 

// 

//" 

/30— 

/ 

/zo — 

/ 

F 

ZOOM. 

/ 

FIG.  2r.  THE  SAME.  RATIO  METHOD. 
A  line  (A)  ascending  at  a  uniform  ratio  in  equal  periods 
of  time,  that  is,  in  geometrical  progression,  is  straight. 
A  line  (B)  ascending  by  equal  differences  in  equal  periods 
of  time,  that  is,  in  arithmetical  progression,  is  curved 
(downward).  Note  that  the  vertical  intervals  increasing 
in  geometrical  progression  (see  the  light  figures)  are 
equally  spaced. 


17] 


The  "Ratio"  Chart 


581 


tween  the  ratio  chart,  and  the  ordinary,  or  difference,  chart, 
is  simply  one  of  spacing,  the  ratio  chart  (as  in  Fig.  2  r)  hav- 
ing the  numbers  120,  130,  140,  etc.  unequally  spaced  whereas 
the  difference  chart  (as  in  Fig.  2  d)  has  these  same  numbers 
equolhj  spaced. 

The  above  description  of  a  method  of  forming  a  ratio  chart 


FIG.    3r.    SCALES  OF  ELEVATIONS  AND  SLOPES.    RATIO  METHOD. 

Showing,  at  the  left,  the  elevations  (and  depressions) ,  representing  various  ratios  of  increase  (or  decrease), 
and  showing,  at  the  right,  the  slopes  representing  various  per  annum  rates  of  increase  (or  decrease). 


will  serve  to  explain  its  nature  as  representing  equal  successive 
percentages  of  increase  by  equal  intervals  on  the  chart. 

In  Fig.  3  r  we  see  the  full  fledged  ratio  chart,  constituting 
a  ruling  arrangement  convenient  for  plotting.  To  familiarize 
the  reader  with  the  graphic  representation  of  ratios,  some  dark 
vertical  lines  are  drawn.     These  show  how  far  up  to  go  to 


582  American  Statistical  Association.  [18 

represent  an  increase  respectively  of  10,  25,  50,  and  100  per 
cent,  (or  2-fold),  5-fold  and  10-fold;  while  the  next  lines  to 
the  right  show  how  far  down  to  go  to  represent  a  decrease  of 
10,  25,  50  (i.e.  "half  of"),  and  90  per  cent.  Any  two 
points  on  the  chart,  however  far  removed  from  each  other 
horizontally,  if  the  vertical  interval  between  them  is  equal  to 
the  10  per  cent,  line,  will  be  such  that  the  statistical  magnitude 
represented  by  the  upper  point  will  be  10  per  cent,  greater 
than  that  represented  by  the  lower.  Again  the  line  repre- 
senting "100  per  cent,  increase  or  2  fold"  is  the  vertical  dis- 
tance between  any  two  points  on  the  chart  of  which  the  upper 
stands  for  twice  the  statistical  number  for  which  the  lower 
stands. 

The  reader  is  advised  to  verify  these  and  the  other  legends 
by  taking  any  two  points  at  random,  reading  the  figures 
opposite  them  in  the  margin  and  comparing  these  figures. 

He  may  also  familiarize  himself  with  the  sloping  lines  at  the 
right  ascending  respectively  at  the  rates  of  1,  2,  5,  10,  25,  50, 
100  per  cent,  five  fold,  and  ten  fold  per  annum,  as  well  as  those 
descending  at  the  rates  of  1,  2,  5,  10,  25,  50,  and  90  per  cent, 
per  annum,  all  drawn  radiating  from  a  center  through  the 
appropriate  points  on  a  vertical  line  one  unit  to  the  right  of 
that  center. 

REPRESENTING     GROWTH     AT     A     CONSTANT,     OR     NEARLY 

CONSTANT,    RATIO. 

The  advantages  of  the  ratio  chart  over  the  difference  chart 
are  many.     They  may  be  seen  from  a  few  illustrative  examples. 

We  have  already  seen  (Fig.  1  r)  that  mere  straightness  of 
the  plotted  line  indicates,  in  the  ratio  chart,  a  uniformity  in 
the  percentage  rate  of  growth,  whereas  in  the  difference  chart 
such  uniformity  is  represented  by  an  exponential  curve  (Fig.  Id). 

In  Fig.  2  d  and  Fig.  2  r  the  same  lines  are  repeated  and 
labelled  A.  The  line  A  represents  a  uniform  percentage  rate 
of  growth.  It  is  an  exponential  curve  in  the  difference  chart 
(Fig.  2  d)  and  a  straight  line  in  the  ratio  chart  (Fig.  2  r). 

For  contrast  a  straight  line  B  is  drawn  on  the  difference 
chart  (Fig.  2  d).  Its  straightness  signifies  little — merely  that 
the  same  absolute  difference  is  added  each  year.     But  the 


19] 


The  "Ratio"  Chart. 


583 


same  absolute  difference  is  a  decreasing  percentage  rate  of 
growth  and  this  fact  is  clearly  interpreted  in  the  ratio  chart 
(Fig.  2  r).  We  may  say  that  the  chief  or  typical  contrast 
between  the  two  charts  is  that  a  straight  line  represents  in 
the  one  an  arithmetical  progression  and  in  the  other  a  geomet- 
rical progression ;  which  is  only  another  way  of  saying  that  it 


A^TJ 


AMn 


0      z 


6   /o  /a  »  f6  /s  ao  da  2-4  £6  as  30  3a  y^  J6 


FIG.    4d.    UNIFORM  PERCENTAGE  RATE.    DIFFERENCE  METHOD. 
Showing  uselessness  of  curve  at  extreme  ends;  also  showing  how  to  compare  percentage  slopes  at 
different  points  by  comparing  (inversely)  the  subtangents  for  these  points.   See  p.  596. 

represents  a  progression  by  equal  differences  in  the  one  and 
by  equal  ratios  in  the  other. 

A  serious  fault  in  the  difference  method  is  that,  in  a  curve 
of  rapid  growth,  the  difference  chart  is  useful  only  in  the  middle 
portion.  At  the  extreme  left  such  a  curve,  e.  g.,  an  exponential, 
or  uniform  percentage,  curve  (as  in  Fig.  4  d)  becomes  almost 
indistinguishable  from  a  horizontal  line  and  at  the  extreme 
right  it  becomes  almost  indistinguishable  from  a  vertical  line. 


584 


American  Statistical  Association. 


[20 


2    2 


CO 

er 
o 


16 10 


1620 


tr:  m 

Ig.  or    s, 

«<■  •      X) 

o.  ,  O 

S  "^ 

g  m 

CO  ^ 

5  « 


IS30 


l»40 


lew 


o 

tr 


(£80 


21] 


The  "Ratio"  Chart. 


585 


2 

a 


Is 

°  2 

CO        1^ 

-■  a 
£  P 

■<  H 
2,  O 
o 

3  o 


SI 
O 


"     GO 

2,  H 


■50     t) 

o 

CD       ^ 

O 

O 


'790 


(800 


laio 


/620 


fd30 


n 

0> 


/6» 


iseo 


'^70 


laao 


/8S0 


rSIO 


586  A7nerican  Statistical  Association.  [22 

At  either  extreme  no  eye  can  estimate  the  percentage  rate  of 
growth  although  that  rate  may  not  be  different  from  the  rate 
in  the  middle. 

A  vast  number  of  statistical  charts  represent  rapid  and  long 
continued  growth, — the  statistics  of  a  prosperous  business 
plotted  from  the  beginning;  the  statistics  of  a  growing  country; 
the  statistics  of  new  inventions.  We  have  merely  to  mention 
any  such  familiar  examples  as  statistics  of  population,  wealth, 
crops,  mining,  manufacturing,  railway  mileage,  telephones, 
automobiles,  bank  deposits,  new  building,  sales  of  stocks,  war 
debts  and  other  magnitudes  rapidly  increasing  since  the  war 
began,  in  order  to  realize  the  thousands  or  rather,  probably, 
the  millions  of  statistical  charts  which  have  been  constructed  of 
this  kind,  most  of  which  are  nearly  useless  at  either  end. 

Thus  Fig.  5  d  represents  the  actual  growth  of  the  population 
of  the  United  States.  The  reader,  however  discerning  or 
experienced,  cannot  discover  by  mere  ocular  inspection  of  this 
curve  whether  the  increase  at  the  end  is  faster  or  slower  than 
at  the  beginning.  Fig.  5  r,  on  the  other  hand,  shows  the  facts 
desired  at  a  glance.  It  shows  a  uniform  rate  of  growth  be- 
tween 1790  and  1860  and  slight  but  evident  changes  since  the 
last  named  date. 

One  great  advantage  of  the  ratio  chart  is  in  forecasting. 
Usually,  in  business,  we  forecast  by  assuming  a  certain  ratio  of 
growth.  In  the  ratio  chart  we  have  simply  to  draw  a  straight 
line;  usually,  in  fact,  merely  to  produce  the  one  already  drawn 
representing  the  rate  experienced  in  the  past. 

One  method  by  which  users  of  the  ordinary  chart  have 
attempted  to  meet  its  shortcomings  in  representing  statistics 
of  rapid  growth  is  first  to  draw  a  "growth  axis, "  or  exponential 
curve  [such  as  that  in  Fig.  1  d,  Fig.  2  d  (curve  A),  or  Fig.  4  d] 
ascending  at  the  average  rate  of  growth  of  the  statistics  under 
consideration;  then  calculate  the  per  cents,  of  deviation  each 
year  from  this  "growth  axis";  and  finally,  plot  these  devia- 
tions on  a  separate  chart. 

This  procedure,  however,  involves,  in  addition  to  charting 
the  original  statistical  figures,  much  subsidiary  calculation  and 
charting;  and  the  results,  when  obtained,  are  not  as  exact  as 
the  results  obtainable  more  easily  by  the  ratio  method. 


23] 


The  "Ratio"  Chart. 


587 


^-^^ 

.- 

^- 

-  •' 

^  - 

- 

"* 

■  ""^ 

/I 

- 

A 

^ 

.'■ 

-H 



■  - 

-- 

-- 

— 

._. 

._- 

-- 

— 

- "~ 

~  — 

y  ~x~jr 

FIG.  6(i.    EQUAL  RATES  OF  GROWTH  APPARENTLY  UNEQUAL.    DIFFERENCE  METHOD. 
Segments  of  two  curves  ascending  at  equal  rates  but  having  unequal  slopes  and  therefore  deceiving 
the  eye. 


COMPARING    CURVES. 

If  we  wish  to  compare  the  growth  of 
population  in  two  countries  of  different 
sizes,  such  as  Canada  and  the  United 
States,  the  ordinary  or  difference  plots, 
of  whi'ch  we  shall  assume  that  AA'  and 
BB^  in  Fig.  6  d  are  small  sections  for  a 
given  year,  will  give  the  impression  that 
the  upper  curve,  i.  e.,  that  for  the  larger 
country ,  is  ascending  at  a  much  faster  ratio 
than  the  lower,  {.  e.,  that  for  the  smaller 
country.  Few  would  suspect  that  the  two 
lines  AA'  and  BB'  represent  precisely  the 
same  percentage  rate  of  growth. 

In  Fig.  6  r,  on  the  other  hand,  the 
equahty  of  these  same  two  rates  of 
growth  is  clearly  indicated  by  the  paral- 
lelism of  the  two  lines  A  A'  and  BB'. 

Again,  if  the  plots  of  the  two  popula- 
tions appear  as  in  Fig.  7  d,  most  persons, 
observing  the  paralldism  of  the  two  lines, 
would  jump  to  the  conclusion  that  the 
two  populations  are  growing  at  the  same 
percentage  rate.  The  fact  is  that  the 
lower  line,  AA',  is  ascending  at  a  greater 
percentage  rate  than  the  upper,  BB'. 
The  ratio  chart  (Fig.  7  r)  shows  this  at 
a  glance. 


S- 


^ 


/ 


A* 


FIG.    6r.       EQUAL       EATES 

OF  GROWTH  EVIDENTLY 

EQUAL.  RATIO  METHOD. 

The  two  segments  are  here 
parallel. 


588 


American  Statistical  Association. 


[24 


In  the  difference  chart,  in  order  to  make  even  a  rough  eye- 
estimate  of  the  comparative  percentage  rates  of  growth  of  A  A' 
or  BB'  (Fig.  6  d  or  Fig.  7  d),we  must:  (1)  note  the  position  of 


:*-» 

t 

/^^ 

z? 

IQ 

^^ 

,  <^ 

n 

^-^ 

ll- 

1 

a 

^ 

^^ 

/I     ^ 

A 

W 
7 

^' 

^ 

^' 

• 

^ 

,^ 

^■' 

^^' 

e 

^    ' 

•   '^ 

.^' 

,^^ 

u 

^    ' 

^  ^ 

^" 

X* 

1 

a 

^ 

> 

^^ 

^^ 

I 

,^' 

.^ 

^^ 

^^ 

1 

r^' 

,^ 

-«''' 

^ 

n 

FIG.  7rf.    UNEQUAL  RATES  OF  GROWTH  APPARENTLY  EQUAL.    DIFFERENCE  METHOD. 
Segments  of  two  curves  ascending  at  equal  slopes,  but  at  unequal  rates  and  therefore  deeei\'ing  the  eye. 


// 

/o 

9 
6 


^ 

6' 

3 

/ 

A 

A 

the  zero  or  base-line,  XX' \  (2)  mentally 
compare  A'X'  with  AX  and  B'X'  with 
BX',  and  (3)  compare  the  two  compari- 
sons. 

Such  mental  operations  are  difficult, 
irksome,  and  inaccurate,  especially  if,  as 
is  not  uncommon,  the  base  or  zero  line 
has  been  omitted  in  order  to  economize 
space.  Furthermore  they  involve  shut- 
ting our  eyes  to  the  slope  or  steepness 
of  the  lines  AA'  and  BB' ,  the  very 
feature  which  first  attracts  attention. 

Often,  in  fact,  the  bottom  part  of  the 
chart,  containing  the  base  line,  is  cut  off, 
and  sometimes,  instead  of  using  the  same 
base  line  for  two  curves  on  the  same  chart  the  draughtsman 
will  bring  one  curve  nearer  the  other  by  using  two  separate 
base  lines.  In  either  event  the  result  is  misleading  or  confusing 
and  in  such  cases  it  is  almost  hopeless  to  obtain  any  clear  idea 


FIG.  7r.  UNEQUAL  RATES 
OF  GROWTH  EVIDENT- 
LY UNEQUAL.  RATIO 
METHOD. 

The  two  segments  are  here  of 
different  slopes  and  the  steeper 
slope  indicates  the  greater  rate 
of  growth. 


25] 


The  "Ratio"  Chart. 


589 


u 

1 

2 

1 

Ct 

— 

— 

/^    ^ 

/J   5 

"v 

•• 

•-. 

., 

f* 

■-' 

'^     N 

- 

" 

'•■, 

*»_ 

-1 

— 

.** 

''      ^ 

A 

*■ 

« 

^1 

~ 

-' 

A 

/o  ^ 

'**! 

,.- 

.-, 

^*' 

^  ^ 

Q   ^ 

s 

I 

7  /V 

v 

"N 

7 

<5 

s 

"N 

•s 

/ 

5 

fl 

iX 

y 

7 

^  /J 

V 

^ 

\ 

^ 

r^ 

7 

-^ 

*v 

•N 

\ 

/ 

^ 

y* 

r 

S  /Z 

A 

\ 

s 

/ 

^ 

X 

r^ 

2 

\ 

k 

/ 

/ 

A 

/    // 

\ 

/ 

%xr  Fnff  f* 

N 

/ 

/o 

9 

6 

7 

c 

FIG.  %i.    JUGGLING  WITH  BASES  AND 
SCALES.    DIFFERENCE  METHOD. 
Curves  A  and  B  apparently  vary  in  exact 
correspondence;  but   if  A  is  ehanged  to  the 
same  base  and  scale  as  that  employed  for  B,  it 
becomes  A',  which  corresponds  much  less  close- 
ly to  B.    The  comparison  between  A  and  B  is 
misleading  and  even  the  comparison  between 
A'  and  B  is  not  exact. 

s 

■4 

3 

£ 

/ 

OASCrOff  A 

1             V,I   '   1    '   :   '   1    !   !   1   1   I   '   M   1   1   1   1   1  ■ 

I     -    'T"'" 

■ 

LI   1 

"T    MM 

M 

j_      ■^i    M 

It 

( 

- 

'3 

t===h+r^ 

t^  J_LL  J 

L^ 

_ 

X 

_ 

-.= 

nU 

T""TTTr 

r"4"^ 

jj-- 

- 

- 

9 
« 

1       1    IN 

|||Mff            III    ji'-lJ 

^" 

^ 

^ 

^ 

5 

Wi 

C 

T^ii^l     1  mtirfr 

'-^"^--p^ 

.    :   -   :j 

S 

S"^n^^ 

^^dfrrrrU^^i 

J-l  1  !  ! 

-r 

°r                  -rrf 

_:■-..■-■-•  -tA 

a 

-J_-^  =  .l_-: 

-H'^A  -'"-^-nr^tf 

= 

= 

\ 

u 

M  M  M  1  \i  1  M  (/  '  1  1  !  1  1 

[^ 

••[   '    i 

i 

:±4  =  i^^^lJiM;\[j!y,  jU:4ifc 

--I- 

Tffl 

== 

z 

^ 

- 

== 

-XI         1  1  M  1  1  !  1  1  1  1  1  1  1  1  1  1  1  i  1  1  1    :   II 

.  J. 

-_zt 

.. 

FIG.    8r.    THE  SAME.    RATIO  METHOD. 

The  comparison  between  A  and  B  here  exactly  represents  the  facts,  showing  only  a  faint  resemblance,  ia 
marked']contrast  with  the  first  comparison  in  the  preceding  figure. 


590 


American  Statistical  Association. 


[26 


lft7fi 

>-* 
-                                               to                       C04i,CT05-^2S2 

1              ,          1         1        1      1           1 

S3     .i*    a 

>  Gc  o  3  5. 

cr 

i«7e 

1879- 
1  fi&n 

\ 

1 
1 

I 

loio 

\ 

\ 

> 

s, 

-    c^L 

lo/y 
-   --  ififin 

looU 

1881- 
1882- 
1883- 

lfiQ/4 

\ 

^s 

.  i 

looU 

-  ififii 

'--, 

^ 

V  s. 

1881 
-    --    1Sfi9 

."^ 

y 

*  i 

18BZ 
IfifiQ 

/ 

/ 

/ 

[S 

18oo 

ieo/1 

lo84- 

1885- 

IRSft 

/ 

f 

/ 

1884 

1S8t 

t 

/ 

1  QCfi 

lOoD- 

1S87 

1 

\ 

1887 

1888- 
1889- 
1890- 
1891- 
1892- 

-■\-- 

\ 

\ 

1888 

^^ 

4 

/ 

1808 
1Q0Q 

a 

f 

I 

\ 

i88y 
1  o<jn 

1: 

*--^ 

isyu 

-ISQt 

cr  C 

7 

i8yi 

1SQ9 

i 

jL8y^ 

-  -    -1 9A% 

1RQ±- 

/ 

lo3u 
-lfiQ/1 

--5 

ISQ'^ 

^* 

f 

Jl8y4 

1 0Qr 

c 

j.oy«>- 

..'' 

f 

loyo 

1  oo/? 

Ig: 

1897- 

1898- 

1 

1 

leyb 

-    --1807 

^fe 

•-. 

1 

isy/ 

i  ^ 

\ 

xooo 

IQAA 

\ 

L 

XOJJ 

iQnn 

§    C 

lyuir 

1901- 

1902- 

1903 

1904 

1905- 

1906 

1907 

1908- 

lOftQ. 

% 

• 

1 

laUU 
IQftl 

..'2 

"**^ 

V 

X    lyui 
J 1  Qn9 

°    E 

-    -     ■^ 

/ 

lyuz 

^1  QftQ 

1  o 

\ 

/ 

— ^xyuo 

1  QA  ,4 

!:•■ 

\ 

V 

iyu4 

lonc 

OB 

> 

lyuo 

lOOA 

• 

V 

\ 

j.yuo 

1 007 

xyu< 

10(18 

\ 

w 

lyus 
1  qno 

lyUJr' 

# 

* 

iQin 

Jiyilr 

1911 
1912 
1913 
1914 
1915 
1916 
1917 

c 

1 

— lyiu 

--1Q1 1 

\ 

lyii 

1019 

> 

/ 

—  j.yiz 

IQ-I  Q 

t 
t 

\ 

lyio 

1  Q 1  A 

*-^ 

\ 

lyi-j 

--    -101  f^ 

7 

^N, 

^iyi<> 

IQIfi 

••  « 

•  -.^ 

s 

k_^  1017 

\xjL  1 

I               \ 

9             « 

s   ? 

9      = 

J    c 

s 

5 

to       E      3 

27] 


The  'Ratio"  Chart. 


591 


B      Z 


592  American  Statistical  Association.  [28 

of  the  comparative  percentage  growths  except  by  recourse  to 
tedious  arithmetical  computations.  Thus  in  Fig.  8  d  the 
curves  A  and  B  seem  to  be  exactly  similar.  But  they  are  far 
less  similar  than  they  appear;  for  the  curve  A  is  relative  to  a 
remoter  base  than  the  curve  B.  If  plotted  on  the  same  base 
and  scale  as  B,  the  curve  A  becomes  A'  and  its  similarity  to  B 
is  greatly  diminished.  But  even  this  degree  of  similarity  is 
greater  than  the  statistics  warrant,  as  we  see  when  using  the 
ratio  chart  (Fig.  8  r).  This  shows  the  exact  degree  of  simi- 
larity of  the  two  curves  A  and  B  which  turns  out  to  be  very 
small.  Thus  the  ratio  chart  is  an  effective  means  of  avoid- 
ing juggling  with  statistics  through  base-selection  or  scale- 
selection. 

Fig.  9  d  and  Fig.  9  r,  taken  from  a  brief  article  of  mine  in 
the  New  York  Times  Annalist  of  March  17,  1917,  show  a  type 
of  error  opposite  to  the  foregoing,  and  one  taken  from  actual 
statistics.  Fig.  9  d  gives  the  impression  that  the  prices  of 
breadstuff s  have  fluctuated  less  than  the  prices  of  "all  com- 
modities." On  the  ratio  chart,  however,  as  shown  in  Fig.  9  r, 
although  exactly  the  same  numbers  are  plotted,  it  is  seen 
that  breadstuffs  have  actually  fluctuated  a  trifle  more  violently 
than  "all  commodities." 

For  comparing  in  detail  any  two  curves  on  ratio  charts, 
such  as  those  in  Fig.  9  r,  we  may  do  what  we  have  just  seen  is 
not  properly  permissible  on  a  difference  chart,^we  may  move 
bodily  either  curve,  the  upper  curve  downward  or  the  lower 
curve  upward,  until  the  two  are  close  together.  Then  the 
various  degrees  of  parallelism  or  divergence,  at  various  periods 
of  time,  may  be  seen  with  the  utmost  clearness.  This  is  done 
in  Fig.  10  ?•.*  Such  close  comparison  will  usually  give  quickly, 
through  the  eye,  a  better  practical  picture,  I  think,  of  the 
degree  of  correlation  and  certainly  of  the  location  of  the  corre- 
lation, than  can  be  obtained  even  by  laborious  calculations  of 
coefficients  of  correlation. 

Index  numbers  "wath  widely  different  bases,  such  as  those  of 
Sauerbeck  and  of  the  United  States  Bureau  of  Labor,  if  plotted 
on  difference  charts  without  especially  selecting  the  scales  or 
without  multiplying  or  dividing  by  suitable  constants,  appear 

•The  scale  on  the  right  applies  to  the  lower  curve,  that  on  the  left  to  the  upper. 


29] 


The  "Ratio"  Chart. 


593 


CO 

cr 
o 


•a 


K 

a 
in 

5' 
on 


5-  S 


■3  S 

« 

CO  M 

o 

cr  CO 

3  O 


c 


C^   1— I 

2.  w 

5  H 

f  o 


St 
5> 


1878 

1879 

11880- 

1881 

1882 

1883 

18844 

1885- 

1886- 

1887- 

1888- 

1889- 

1890- 

1891- 

1892- 

1893- 


o 


18941 

1895- 

189(i-t-^ 

1897-p^ 

1898- 

1899- 

1900- 

1901- 

1902 

1903- 

1904 

1905- 

1906 

1907- 

1908- 

1909-h 

1910 

1911- 

1912 

1913 

1911 

1915 

191G 

1917 


694  American  Statistical  Association.  [30 

far  more  different  from  each  other  than  they  really  are. 
Ratio  plotting  will  show  their  exact  similarities  and  differences. 

As  was  said  at  the  outset,  difference  charts  are  useful  when 
difference  comparisons  are  wanted.  Not  only  are  such  cases 
rare,  however,  but  often  difference  comparisons  between  curves 
are  meaningless,  and  ratio  comparisons  are  alone  possible. 
This  is  the  case  when  two  curves  represent  incommensurable 
magnitudes  as,  for  instance,  when  a  curve  of  railway  gross 
receipts  is  compared  with  one  of  population  or  one  of  the  cir- 
culation of  money  with  one  of  the  price  level.  In  such  cases 
difference  plotting  involves  a  very  dangerous  discretion  in 
selecting  the  scale  and  the  base  in  order  neither  to  exaggerate 
nor  to  understate  the  degree  of  correspondence.  For  instance, 
the  close  similarity  in  the  recent  changes  in  the  money  in 
circulation  in  the  United  States,  on  the  one  hand,,  and  the 
price  level,  on  the  other,  was  not  evident  to  me  until  I  plotted 
the  two  curves  on  a  ratio  chart  (Fig.  11  r).  This  similarity 
might  be  almost  overlooked  on  a  difference  chart  if  the  scales 
for  dollars  and  index  numbers  were  selected  arbitrarily. 

One  special,  though  slight,  advantage  of  the  ratio  chart  is  in 
representing  more  clearly  than  in  the  difference  chart  the 
results  of  multiplying  or  dividing  a  statistical  series  of  numbers 
by  a  constant,  or  by  another  series,  and  in  exhibiting  the 
resultant  third  series  relatively  to  the  other  two.* 

ATTEMPTS  TO  MEND  THE  FAULTS  OF  THE  DIFFERENCE  CHART. 

One  attempt  to  secure  better  comparability  of  curves  in 
ordinary  plotting  is  that  customary  in  handling  index  numbers, 
— namely  to  reduce  all  prices  to  percentages  of  the  base-period 
price,  so  that  we  may  start  all  the  curves  at  an  even  100  per 

*In  detail:  (1)  to  multiply  or  divide  by  a  constant  any  series  of  numbers  plotted  in  a  curve  is  merely  to 
shift  the  curve  bodily  up  or  down  by  the  appropriate  constant  distance;  (2)  the  reciprocals  (of  a  statistical 
series  p  lotted  i  n  a  curve)forin  a  second  curve  symmetrical  (relatively  to  the  unity  line)  to  the  first  curve ;  in 
other  words  two  curves  representing  reciprocal  numbers  are  such  as  to  coincide  if  the  chart  is  folded  over 
the  unity  line;  thus  a  plot  representing  an  index  number  of  prices  will  be  the  exact  reverse  of  that  repre- 
senting the  purchasing  power  of  money,  the  one  ascending  whenever  the  other  descends  and  at  the  same 
angle;  (3)  the  eorve  formed  by  plotting  the  products  of  two  series  will  be  such  that  its  distances  from 
the  unity  line  will  be  the  sum  of  the  differences  of  the  other  two  from  that  line;  (4)  analogously,  a  quo- 
tient of  two  curves  is  distant  from  the  unity  line  the  difference  of  their  distances  (t.  e.,  distance  of  the 
dividend  curve  less  that  of  the  divisor  curve).  Thus  if  we  plot  a  curve  of  acres  per  capita  of  wheat 
lands  and  another  of  bushels  per  acre  and  then  plot  the  curve  of  their  products,  i.  e.,  of  bushels  per  capita, 
the  three  curves  will  be  seen  to  be  related  as  just  described;  the  same  would  apply  to  index  numbers  of 
prices,  of  wages,  and  of  purchasing  power  of  wages  ("real  wages"). 


31] 


The  "Ratio"  Chart. 


595 


cent.  If  the  curves  do  not  greatly  diverge  this  gives  approx- 
imately correct  results.  But  it  is  a  makeshift  method  and 
never  gives   the  absolutely  exact  comparisons  of   the  ratio 

Xndeji. 

'^TcJA'  '®"    '^'^    '3 '5    /9/^    Id  IS    'die    Id  11 


Moneu 
1  n     ' 
Bill  Tons 

—  &5.0 


-     4.5 


40 


3.5 


30 


FIG.    llr.    MONEY  AND  THE  PRICE  LEVEL.    RATIO  METHOD. 
Showing  the  exact  degree  in  which  the  price  level  in  the  United  States  has  fluctuated  in  comparison  with 
the  amount  of  money  in  circulation.    Since  the  war,  there  has  been  a  close  correspondence,  changes  in  the 
price  level  following  changes  in  money  by  two  or  three  months. 


method;   and,  after  the  curves  have  diverged  considerably, 
their  correct  comparison  becomes  difficult. 

Another   method   is   that   suggested   by   Professor    Alfred 


596  American  Statistical  Association.  [32 

Marshall.  It  consists  in  making  a  special  geometric  con- 
struction.* But  recourse  to  geometric  construction  is  slow 
and  inexact  and  does  not  appeal  to  the  eye. 

As  a  matter  of  fact,  users  of  charts,  when  seeking  percentage 
comparisons,  are  apt  simply  to  read  off  the  four  numerical 
figures  opposite  the  various  points  (as  A  and  A'  and  B  and  B' 
in  Fig.  6  d  or  Fig.  7  d)  and  compute  arithmetically  the  two 
percentage  rates  of  increase,  {i.  e.,  the  percentage  excess  of 
height  of  A'  over  A  and  that  of  B'  over  B) .  But  such  a  proce- 
dure is  nothing  less  than  giving  up  the  use  of  the  diagram  as 
a  diagram  and  using  it  merely  as  a  table  of  arithmetical  figures. 
A  diagram  is  supposed  to  interpret  figures  to  the  eye  and  to 
need  no  interpretation  itself  through  arithmetical  processes. 
When  it  does  need  such  interpretation,  it  fails  of  its  purpose 
as  a  quick,  clear,  convenient,  and  reliable  picture. 

Finally  we  note  that  the  foregoing  correctives  and  safeguards 
necessary  for  using  the  "difference"  method  correctly  are,  in 
actual  fact,  almost  invariably  neglected.  Practically  no  one 
uses  Marshall's  subtangent  comparison;  few  even  mentally 
measure  the  heights  of  points  above  the  base  line, — much  less 
mentally  reckon,  from  these  heights,  the  percentage  rates  of 
change;  few  even  notice  whether  the  base  line  is  inserted  or  omit- 
ted or  whether  there  are  different  base  Unes  for  different  curves 
whose  inconsistency  needs  to  be  allowed  for;  growth  axes  are  sel- 
dom constructed;  few  make  any  effort  to  shut  their  eyes  to 
straightness  or  parallelism  in  order  to  avoid  being  misled  into 
assuming  uniformity  or  similarity  of  percentage  changes;  few, 
even,  use  a  diagram  as  a  table  of  figures. 

Professor  Marshall  says  of  the  ordinary  method  of  curve- 
plotting:  "Its  defects  are  such  that  many  statisticians  seldom 
use  it  except  for  the  purpose  of  popular  exposition,  and  for 
this  purpose,  I  must  confess,  it  has  great  dangers. "  t    A  business 

•  "  On  the  Graphic  Method  of  Statistics, "  Jubilee  Vol.  of  the  Royal  Statistical  Society,  1885,  pp.  251-60. 
To  help  translate  the  deceptive  slope  of  different  lines,  such  as  A  A'  and  BB'  in  Fig.  6  dor  Fig.  7  d,  we  pro- 
duce these  lines  so  that  they  cut  the  base  line.  If,  when  so  produced,  they  are  found  to  cut  the  base  line 
at  the  same  point,  as  is  the  case  in  Fig.  6  d,  where  they  both  cut  at  Y,  then  we  may  know  that  they  have 
the  same  percentage  slope.  If,  as  in  Fig.  7  d,  they  do  not  cut  the  base  line  in  the  same  point,  the  one  which 
cuts  the  further  off  has  the  smaller  percentage  rate  of  increase  and  the  rates  of  increase  per  annum  of  the 
two  lines  at  A  and  B  are  inversely  proportional  to  the  distances  at  which  they  cut  the  base  as  measured 
from  A'.  Thus  if,  in  Fig.  7  d,  AT  is  14/20  of  XZ  the  percentage  change  at  A  is  20/14  of  that  at  B. 
Again,  in  Fig.  4  d  the  S'lopcs  at  A  and  A'  are  equal,  as  XY^X'V.  All  of  these  results  may  be  proved 
geometrically. 

t  "On  the  Graphic  Method  of  Statistics,"  Journal  of  the  Royal  Statistical  Society,  1885,  p.  251. 


33]  The  ''Ratio''  Chart.  597 

man  whose  attention  was  recently  called  to  the  advantages  of 
the  ratio  chart  recharted  his  business  statistics  and  was  startled 
to  discover  how  he  had  been  misled  by  the  ordinary  method. 

After  such  a  severe,  but,  I  beHeve,  just,  indictment  against 
ordinary  or  "difference"  plotting  it  may  be  asked  whether,  as 
usually  employed,  such  plotting  is  not  worse  than  useless.  It 
is  certainly  true  that  ordinarily  it  misleads  to  some  extent.  I 
have  sometimes  found  myself  hesitating  to  use  a  curve  in  a  pub- 
lication, because,  on  the  one  hand,  of  the  space  it  would  take  up 
if  the  base  line  were  inserted  and,  on  the  other,  of  the  mistaken 
impression  it  might  make  if  the  base  line  were  omitted. 

The  best  that  can  be  said  for  the  difference  method  is:  it 
always  shows  whether  there  is  an  increase  or  decrease;  it 
usually  displays  the  grosser  contrasts  at  a  glance;  the  base  or 
zero  line  gives  a  means,  lacking  in  the  ratio  method,  for  plotting 
zeros,  for  comparing  positive  and  negative  quantities,  and  for 
seeing  in  a  simple  and  self-evident  comparison  the  vertical 
elevations  of  points  in  a  curve  above  the  base  line. 

WAYS    OF    UTILIZING    DIRECTION    IN    THE    RATIO    CHART. 

The  eye  reads  a  ratio  chart  more  rapidly  than  a  difference 
chart  or  a  table  of  figures.  We  may  recapitulate  what  most 
easily  catches  the  eye  as  follows: 

1.  If  we  see  a  curve  ascending,  and  nearly  straight,  we  know 
that  the  statistical  magnitude  it  represents  is  increasing  at  a 
nearly  uniform  rate. 

2.  If  the  curve  is  descending,  and  nearly  straight,  the  sta- 
tistical magnitude  is  decreasing  at  a  nearly  uniform  rate. 

3.  If  the  curve  bends  upward  the  rate  of  growth  is  increasing. 

4.  If  downward,  decreasing. 

5.  If  the  direction  of  the  curve  in  one  portion  is  the  same 
as  in  some  other  portion  it  indicates  the  same  percentage 
rate  of  change  in  both. 

6.  If  the  curve  is  steeper  in  one  portion  than  in  another 
portion  it  indicates  a  more  rapid  rate  of  change  in  the  former 
than  in  the  latter. 

7.  If  two  curves  on  the  same  ratio  chart  run  parallel  they 
represent  equal  percentage  rates  of  change. 

8.  If  one  is  steeper  than  another  the  first  is  changing  at  a 
faster  percentage  rate  than  the  second. 


598  American  Statistical  Association.  [34 

9.  The  imaginary  straight  Une  most  nearly  representing, 
to  the  eye,  the  general  trend  of  the  curve,  is  its  "growth  axis, " 
and  represents  the  average  rate  of  increase  (or  decrease) ;  and 
the  deviations  of  the  curve  from  this  growth  axis  are  plainly 
evident  without  recharting. 

10.  The  slope  of  the  imaginary  line  between  any  two  points 
on  a  curve  indicates  the  average  rate  of  change  between  the 
two. 

WAYS    OF    UTILIZING    ELEVATION    IN    THE    RATIO    CHART. 

The  preceding  relates  to  direction.  As  to  elevation,  the  eye 
can,  with  a  little  famiharity,  translate  vertical  elevation  into 
numerical  ratio;  for,  as  we  have  seen,  a  certain  elevation  re- 
presents a  10  per  cent,  increase,  another  a  100  per  cent,  in- 
crease, or  doubling,  etc.,  etc.* 

To  one  accustomed  to  using  the  difference  chart  the  use  of 
elevations  on  the  ratio  chart  may  at  first  be  confusing.  But 
only  a  few  minutes  are  necessary  to  learn  its  use;  and  this  use 
of  the  mere  elevation  for  measuring  the  ratios,  or  vertical 
distances,  between  any  two  points  between  the  two  magnitudes 
represented  by  those  points,  is  really  easier  and  more  exact  than 
the  more  self-evident  method,  in  the  ordinary  chart,  of  com- 
paring their  two  vertical  distances  from  the  base  line.f 

*  For  roughly  interpreting  elevations  without  having  to  read  the  marginal  figures  or  measure  dis- 
tances, the  original  system  of  equidistant  horizontals,  as  shown  in  Fig.  1  r,  is  not  inconvenient.  The 
chart  is  divided  into  horiaontal  10  per  cent,  bands  and  the  eye  can  approximately  reckon  how  far  any 
point  on  a  statistical  curve  is  vertically  above  any  otho*  point, — whether  one  band's  breadth,  or  two, 
or  any  fractional  part,  and,  therefore,  whether  it  represents  a  magnitude  10  per  cent,  more,  or  10  p:r 
cent,  more  than  10  per  cent,  more,  i.  «.  21  per  cent,  more,  etc. 

fWe  may  also,  if  we  wish,  make  much  more  exact  comparisons  than  those  afforded  by  the  glance  of  an 
eye.  We  may  exactly  measure  any  slope  such  as  that  of  a  tangent  to  a  curve  at  any  point  or  such  as  that  of 
a  line  connecting  any  two  points  on  the  curve.  This  may  be  done  in  accordance  with  the  constructions  of 
the  radiating  lines  in  Fig.  3  r;  by  drawing  a  line  parellel  to  that  of  which  the  slope  is  desired,  from  any 
convenient  point  in  the  horizontal  line  "  10".  Let  this  cut  the  vertical  Une  one  unit  to  the  right  of  said 
point;  the  height  of  this  intersection  above  (or  below)  line  "  10"  measures  exactly  the  rate  of  ascent  (or 
descent)  of  the  slope  to  be  measured. 

Again  we  may  exactly  measure  any  ratio  comparison  between  two  points  on  the  same  curve — or  on  differ- 
ent curves  for  that  matter.  All  we  need  to  know  is  the  vertical  distance  between  the  two  points  and 
compare  this  with  the  vertical  scale  above  (or  below)  the  line  "  10, "  as  illustrated  in  Fig.  3  r.  Such  a  com- 
parison may  be  made  by  a  draughtsman's  dividers,  parallel  rulers,  sliding  triangle,  or  even  by  using  the 
edge  of  a  sheet  of  paper  and  a  lead  pencil.  Thus,  if  the  elevation,  as  measured,  is  found  equal  to  the  distance 
between  "  1 "  and  "  2 "  (or  "  10 "  and  "  20 "  or  "  100 "  and  "  200 ")  then  the  upper  point  represents  a  statistical 
magnitude  just  twice  that  represented  by  the  lower  point;  or  again,  if  the  measured  elevation  is  equal  to 
the  distance  between  "  1"  and  "1.37"  (or  "10"  and  "13.7"  or  "100"  and  "137")  on  the  scale,  then  the 
upper  point  represents  a  statistical  magnitude  37  per  cent,  greater  than  that  represented  by  the  lower 
point. 


35]  The  "Ratio"  Chart.  599 

SUMMARY. 

In  the  ratio  method,  then,  a  straight  Hne*  always  represents 
a  constant  percentage  rate  of  increase  or  decrease  and,  con- 
versely, a  constant  percentage  rate  of  increase  or  decrease  is 
always  represented  by  a  straight  line;  a  curve  deviating  from 
a  straight  line  invariably  implies  that  the  percentage  of  change 
deviates  correspondingly  from  constancy;  any  two  curves  or 
two  portions  of  the  same  curve  which  are  parallel  represent 
exactly  equal  percentage  rates  of  change;  any  two  curves  or 
portions  of  curves  which  show  a  contrast  of  direction  always 
indicate  a  corresponding  contrast  in  percentage  change;  if  the 
numbers  plotted  are  halved  or  changed  in  any  other  ratio,  the 
resulting  curve  will  simply  be  raised  or  lowered  but  will  main- 
tain exactly  the  same  series  of  directions  and  therefore  present 
the  same  appearance  to  the  eye;  if  the  scale  is  properly  selected, 
a  curve  is  never  nearly  horizontal  except  when  it  actually 
represents  an  almost  infinitesimal  rate  of  increase  or  decrease, 
nor  is  it  ever  nearly  vertical  except  when  it  actually  represents 
a  rate  correspondingly  enormous;  as  there  is  no  zero  line  there 
is  no  waste  space  on  its  account  and  the  diagrams  can  be  cut 
off  close,  both  above  and  below  the  curve;  there  can  be  no 
juggling  with  base  lines  or  scales;  there  is  no  need  of  special 
supplementary  geometric  constructions,  such  as  Marshall's 
subtangent  construction;  there  is  no  need  of  laborious  calcu- 
lations to  reduce  original  figures  to  index  numbers  or  per- 
centages; there  is  no  need  of  eliminating  the  growth  axis 
{which,  in  the  ratio  method,  is  simply  a  straight  line,  the  per- 
centage deviations  from  which  are  apparent  without  special 
calculation  or  replotting). 

The  features  of  a  curve  which,  whether  we  will  or  not,  most 
"catch"  the  eye  are  concerned  with  comparative  direction, — 
straightness  or  curvedness;  steepness  or  flatness;  parallelism 
or  divergence.     These  features  therefore  ought  to  be,   not 

•It  is  intereating  to  note  that  engineers  have  found  it  advantageous  to  devise  special  plotting  charts 
which  will  reduce  parabolic,  hyp?rbolic  and  probability  curves  of  the  ordinary  charts  to  straight  lines  on 
the  special  charts,  e.  g.,  see  A.  S.  Langadorf,  "Methods  for  Determining  the  Equations  of  Experimental 
Curves,"  Journal  of  the  Association  of  Engineering  Societies,  June,  1901,  pp.  325-43;  L.  F.  Harza,  "Notes 
on  Determination  of  Experimental  Equations,"  Wisconsin  Engineer,  December,  190S;  George  C.  Whip- 
ple, "Element  of  Chance  in  Sanitation,"  Journal  of  the  Franklin  Institute,  Vol.  182,  July  7,  1916,  p.  37; 
Alien  Hazen,  "Storage  to  be  Provided  in  Impounding  Reservoirs  for  Municipil  Water  3upp'.y,"  Pro- 
ceedings of  the  American  Society  of  Civil  Engineers,  Nov.,  1913. 


600  American  Statistical  Association.  [36 

snares  nor  stumbling  blocks,  as  they  are  in  the  "difference" 
chart,  but  aids  or  sign  boards  as  they  are  in  the  "ratio"  chart. 

And,  besides  the  full  utilization  of  direction,  we  have,  in  the 
ratio  chart,  that  of  elevation.  While  the  interpretation  by  the 
eye  and  mind  of  elevation  requires  a  little  preliminary  training 
it  soon  becomes  easier,  more  rapid  and  more  accurate  than 
the  corresponding  procedure  for  difference  charts. 

In  a  word,  the  ratio  chart  simply  utilizes  the  natural  powers 
of  the  eye.  Consequently,  when  one  is  once  accustomed  to  it, 
it  never  misleads,  but  always  pictures  a  multitude  of  ratio 
relations  at  a  glance,  with  absolute  fidelity  and  without  the 
annoyance  of  reservations  or  corrections. 

BIBLIOGRAPHY. 

Professor  Jevons  seems  to  have  been  the  first*  to  employ 
the  idea  of  the  ratio  chart.  He  did  not  use  prepared  ruling 
but  employed  a  table  of  logarithms  and  plotted  the  logarithms 
of  the  statistical  numbers.  While  this  procedure  amounts 
to  the  same  thing  it  fails  to  interpret  the  method  to  the  aver- 
age man,  for  it  seems  to  lose  touch  with  the  actual  statistical 
figures. 

W.  S.  Jevons,  Investigations  in  Currenaj  and    Finance,  London,   (Mac- 

millan)  1S84,  pp.  53,  128,  150. 
Alfred  Marshall,  On  the  Graphic  Method  of  Statistics,  Jubilee  Volume 

of  the  Royal  Statistical  Society,  June  22-24,  1885,  p.  258. 
George    H.  Wood,   Some   Statistics  relating  to   Working  Class   Progress 

since  I860,    Journal  of  the  Royal  Statistical  Society,  December,  1899, 

p.  660. 
Arthur  L.  Bowley,   Elements  of  Statistics,  London   (King),   1901,  pp. 

188-196. 
R.  Benini,   Principi4    di   Statistica  Metodologica,   Torino   (Unione  Tipo- 

grafico-Editrice  Torinese),  1906,  pp.  144-148. 
W.  J.  Cunningham,  The  Logarithmic  Scale  in   Graphic   Charts,    Railroad 

Age  Gazette,  June  25,  1909,  pp.  1517-19. 
Walter  T.  Ray,  Rational  Stock  Speculation,  Norfolk,  Va.  (published  by 

the  author),  1914,  Vol.  1,  pp.  15-20. 

•"During  the  years"  (viz.,  1863  to  1884)  "which  have  elapsed  since  this  paper  and  previous  essays  on 
the  value  of  gold  were  printed,  I  have  not  happened  to  learn  that  logarithmic  diagrams  had  been  Msed 
before  their  employment  in  these  inquiries.  It  must  be  evident,  however,  that  they  furnish  the  true  mode 
of  representing  all  statistical  and  other  numbers  of  which  the  ratios,  not  the  absolute  amounts,  are  in 
question.  Now  this  is,  strictly  speaking,  the  case  with  almost  all  numbers  used  for  statistical  research, 
as  apart  from  mere  practical  accounts."  W.  S.  Jevons,  "Investigations  in  Currency  and  Finance," 
London,  (Macmillan),  1884,  p.  128. 


37]  The  "Ratio"  Chart.  601 

WiLLARD  C.  BrintoN;  Graphic  Methods  for  Presenting  Facts,   New  York 

(Engineering  Magazine  Company),  1914,  pp.  132-7. 
WiLLARD  C.  Brinton  and  others,  Preliminary  Report  of  the  Joint  Com,' 

mittee  on  Standards  for  Graphic  Presentation,  1915,  p.  5.     Printed  by 

the  American  Society  of  Mechanical  Engineers. 
Irving  Fisher,  Plotting  Ratios  Along  with  Amounts,  New  York  Times 

Annalist,  March  19,  1917,  p.  398. 
John  Wenzel,  Graphic  Charts,  Scientific  American  Supplement,  No.  2154, 

April  14,  1917,  p.  236. 


^ 


SALE  OF  INTOXICATING  LIQUORS 


STATEMENT 


OF 


PROF.  IRVING  FISHER 

PROFESSOR  OF  POLITICAL  ECONOMY 
YALE  UNIVERSITY 


BEFORE  A 

SUBCOMMITTEE  ON  EXCISE  AND  LIQUOR  LEGIS- 
LATION OF  THE  COMMITTEE  ON  THE 
DISTRICT  OF  COLUMBIA 

MARCH  7,  1912 


WASHINGTON  :  GOVERNMENT  PRINTING  OFFICE  :  1912 

42108—12 1 


STATEMENT  OF  PROF.  IRVING  FISHER,  PROFESSOR  OF  POLITICAL 

ECONOMY,  YALE  UNIVERSITY. 

Senator  Works.  Professor,  you  have  had  occasion  to  study  this 
question  of  the  effect  of  alcoholic  drinks,  and  the  committee  is  inves- 
tigating the  question  of  controlling  the  saloons.  We  would  be  very 
glad  to  have  your  views  upon  that  or  any  other  feature  of  it  you 
desire  to  take  up.  You  might  first  tell  the  committee  what  your 
occupation  is. 

Prof.  Fisher.  I  am  professor  of  political  economy  at  Yale  Uni- 
versity, and  president  of  the  committee  of  one  hundred  on  national 
health,  which  was  appointed  by  the  xVmerican  Association  for  the 
Advancement  of  Science. 

I  have  been  interested  in  the  question  of  alcohol  for  a  number  of 
years.  I  did  not  know  that  I  was  to  appear  before  this  committee 
when  I  came  to  Washington,  otherwise  I  should  have  come  with 
statistics  which  I  can  only  give  now  offhand,  without  the  actual 
figures. 

The  Chairman.  I  would  suggest,  Professor,  that  when  you  return 
home,  if  there  is  any  memoranda  you  desire  to  send  to  the  committee, 
we  will  be  glad  to  have  it  put  into  the  record. 

Prof.  Fisher.  I  shall  be  very  glad  to  do  that,  sir.  I  have  been 
interested  in  the  problem  for  a  number  of  years,  having  some  13 
years  ago  lost  my  own  health  and  regained  it  a  short  time  after.  I 
became  interested  in  public  health  in  relation  to  myself  and  in  rela- 
tion to  my  profession  of  political  economy,  and  for  the  last  12 
years  I  have  been  making  a  study  of  the  relation  of  health  and  dis- 
ease to  economics,  its  relation  to  the  laboring  classes,  its  relation  to 
industry;  and  when  the  committee  of  one  hundred  on  national 
health  was  appointed  by  the  American  Association  for  the  Advance- 
ment of  Science  five  years  ago  I  undertook  the  preparation  of  a 
report,  which  later  was  presented  to  President  Roosevelt  as  a  part 
of  the  report  of  the  conservation  commission  of  which  I  was  a  mern- 
ber.  In  this  report,  which  endeavored  to  cover  the  subject  of  public 
health  in  the  United  States,  I  found  it  necessary  to  pay  consid- 
erable attention  to  the  effects  of  alcohol. 

After  making  what  I  believe  was  a  thoroughly  disinterested  study 
of  the  question,  being  perfectly  willing  to  be  convinced  that  alcohol 
is  a  benefit  or,  within  limits,  is  a  benefit,  or  at  any  rate  not  an  injury, 
I  came  personally  very  strongly  to  the  conclusion,  on  the  basis  of 
statistics  as  well  as  on  the  basis  of  physiology,  that  alcohol,  so  far  as 
we  can  observe  its  effects,  is  an  evil  and  no  benefit.  As  soon  as  the 
effects  manifest  themselves,  they  are  injurious  and  not  beneficial.  It 
is  not  what  we  could  properly  call  a  stimulant,  but  it  is  a  depressant. 
It  is  apparentlv  a  stimulant,  because  it  puts  to  sleep  the  nerves  that 
indicate  fatigue,  so  the  person  says  that  it  relieves  fatigue.  What 
it  does  is  to  make  you  unconscious  of  fatigue. 

This  summer  I  visited  the  great  international  hygiene  exhibition 
in  Dresden,  in  which  was  represented  the  public-health  work  of  all 

3 


4  SALE    OF   INTOXICATING   LIQUORS. 

the  nations  of  the  world,  with  the  one  exception,  I  am  regretful  to 
say,  of  the  United  States  of  America.  That  was  a  world's  fair  de- 
voted to  health,  one  of  the  most  wonderful  exhibits  which  has  ever 
been  seen,  the  cost  being  over  a  million  dollars,  and  being  visited  by- 
many  millions  of  people. 

I  was  very  much  surprised  to  see  that  in  Germany,  an  alcoholic- 
using  nation,  distinctively  a  beer-dringing  nation,  that  so  much  at- 
tention was  given  to  the  evils  of  alcohol,  and  I  found  that  at  this 
exhibit  there  were  a  number  of  interesting  and  new  statistics  on  the 
subject,  and  facts  brought  out  by  physiologists,  and  a  daily  demon- 
stration by  a  skilled  expert  on  alcohol,  which  was  listened  to  with 
ver}'-  great  attention  by  all  of  the  visitors  there,  including  the 
Germans. 

I  also  found  that  the  Kaiser  was  encouraging  this  antialcohol 
movement  in  Germany,  that  he  had  spoken  against  alcohol,  had  given 
it  up  absolutely  in  his  own  household,  had  selected  the  university 
to  which  to  send  his  sons,  on  the  basis  largely  of  the  fact  that  that 
university  had  less  of  the  fashion  of  beer  drinking  than  any  other 
university  in  Gemiany. 

I  found  also  the  statistics  of  Germany,  taken  from  the  recent  scien- 
tific movement  against  alcohol — I  want  to  emphasize  that  word 
"scientific,"  because  it  is  not  the  kind  of  an  alcohol  movement  that 
we  are  accustomed  to  think  of  in  this  couiitr}^ — showed  that  there 
has  been  a  striking  diminution  in  the  use  of  alcoholic  beverages,  in- 
cluding beer,  in  Germany.  Concomitant  with  this  there  has  been  a 
decline  in  the  death  rate. 

I  was  particularly  interested  to  see  the  statistics  for  Sweden.  I 
came  away  from  this  international  exhibition  wath  the  feeling  that 
Sweden  is  the  most  advanced  nation  hygienically  in  the  world.  Its 
people  have  the  longest  duration  of  life,  the  smallest  mortality,  the 
smallest  infant  mortality,  the  smallest  mortality  in  old  age,  the 
smallest  mortality  all  along  the  line.  Not  only  that,  but  its  improve- 
ment in  mortality  during  recent  years  has  been  greater  than  any 
other  nation,  although  there  is  less  room  there  for  improvement  than 
in  any  other  nation. 

They  have  kept  their  vital  statistics  for  150  years — longer  than  any 
other  "nation  has  kept  them.  They  have  kept  the  record,  and  they 
have  read  the  record,  and  when  they  had  found  by  these  vital  sta- 
tistics, wdiich  are  really  vital  bookkeeping,  that  they  were  losing  in 
a  particular  way  they  tried  to  remedy  that.  Swedish  massage, 
Swedish  gymnastics,  Swedish  hard  bread,  Swedish  school  hygiene, 
Swedish  inspection  of  school  children,  and  various  other  facts,  have 
cooperated  in  this  movement  toward  better  living  conditions  and 
better  health.  But  in  particular  there  has  been  a  fight  against  alco- 
hol there,  so  that  the  reduction  in  the  consumption  of  alcohol  has 
been  more  striking,  I  think,  than  in  any  other  nation.  Judging  from 
the  impression  that  I  got  from  looking  at  the  statistics  there  that 
is  true.  At  any  rate,  there  has  been  a  very  great  reduction.  I 
would  not  dare  say  offhand  what  per  cent,  but  looking  at  the  curves 
there  we  found  that  per  capita  of  alcoholic  consumption  had  remained 
absolutely  constant  for  a  number  of  years,  but  during  the  last  decade 
or  two  had  sharply  fallen  off. 


SALE    OF   INTOXICATING   LIQUORS.  5 

The  Chairman.  What  has  been  the  result  in  the  vital  statistics 
since  that  time? 

Prof.  Fisher.  The  improvement  during  the  past  few  decades  there 
has  been  as  great  as  in  almost  any  other  nation.  I  think  not  as 
great  as  in  Prussia,  but  Prussia  had  more  room  for  improvement. 

The  Chairman.  The  improvement  begins,  you  might  say,  with 
the  diminution  in  the  use  of  alcohol? 

Prof.  Fisher.  The  improvement  has  been  going  on  in  the  last  150 
years,  but  it  has  been  going  on  more  rapidly  of  late,  and  especially 
of  the  diseases  of  late  in  life. 

Senator  Works.  By  what  means  have  they  reduced  the  consump- 
tion of  alcoholic  drinks? 

Prof.  Fisher.  They  have,  by  means  of  what  is  called  the  Guten- 
berg system,  b}^  means  of  which  the  State  takes  charge  of  the  liquor 
traffic,  does  not  sell  to  minors,  and  attempts  to  discourage  the  prac- 
tice, and  educates  the  people  w^ho  come  in  to  buy  alcohol  as  to  its 
effects  upon  them. 

The  Chairman.  The  State  controls  it,  or  rather  the  sales  ? 

Prof.  Fisher.  Yes. 

The  Chairman.  It  does  not  leave  it  in  the  hands  of  private 
parties  ? 

Prof.  Fisher.  In  Germany  the  fight  against  it  is  conducted  on 
other  lines,  mostly  educational.  The  reason  Sweden  has  shown  a 
greater  improvement  in  mortality  in  later  ages  in  life  as  well  as 
earlier  ages  in  life  is  that  they  are  fighting  alcoholic  diseases  as  well 
as  degenerative  diseases.  There  are  two  great  classes  into  which 
we  may  divide  diseases:  The  acute  diseases,  which  are  of  the  in- 
fectious type,  such  as  pneumonia,  smallpox,  diphtheria,  which  are 
more  or  less  self-limiting,  which  come  suddenly  and  go  suddenly; 
then  there  are  the  chronic  diseases,  which  might  be  called  the  de- 
generative diseases,  or  constitutional  diseases,  which  come  in  grad- 
ually or  insidiously,  such  as  rheumatism,  gout,  Bright's  disease, 
diseases  of  the  heart  and  nerves. 

In  most  countries  the  public-health  fight  has  been  almost  exclu- 
sively against  the  first  type,  and  as  a  consequence  they  have  im- 
proved the  death  rate  of  the  diseases  of  earlier  in  life,  where  the 
danger  from  these  diseases  is  greater,  and  the  consequence  is  that 
in  England,  the  United  States,  and  other  countries  there  has  been 
a  decline  in  the  death  rate  up  to  50  years.  Beyond  50  years  it  is 
greater  than  it  used  to  be  in  some  cases.  In  the  United  States  it  is 
greater  than  it  used  to  be  beyond  60  years. 

In  Sweden  the  opposite  is  true.  It  is  true  all  along  the  line,  and 
the  reason  for  it  is  that  Sweden  is  fighting  the  degenerative,  the 
chronic  diseases,  just  as  effectively  as  it  is  fighting  the  infectious 
diseases.  The  method  of  fighting  the  infectious  disease  is  by  quar- 
antine, public-health  sanitation.  The  method  of  fighting  the  de- 
generative disease  is  through  personal  hygiene,  and  the  question  of 
Sie  individual  taking  care  of  himself,  the  question  of  fresh  air,  sleeping 
out  of  doors,  living  out  of  doors  and  taking  exercise,  questions  of 
attire,  and  questions  of  mental  attitude.  These  are  the  methods  by 
vhich  the  degenerative  diseases  are  combatted,  and  I  believe  that 
in  personal  hygiene  one  of  the  most  important  branches  is  the  use  one 
makes  of  alcoholic  beverages. 


6  SALE    OF   INTOXICATING   LIQUOES. 

Sweden  has  come  to  this  eonchision,  and  as  a  consequence  they 
have  found  a  decline  in  the  death  rate  not  only  under  50  years  of  age, 
but  after.  Another  most  remarkable  movement  in  mortality  in 
Europe  has  been  in  the  city  of  London.  I  think  it  is  one  of  the 
wonders  of  the  world  that  the  death  rate  in  London  has  been  de- 
creased as  it  is,  and  it  has  been  a  puzzle  to  me  to  find  out  exactly  why. 
I  believe  it  is  due  to  a  combination  of  causes.  As  a  matter  of  fact, 
the  death  rate  in  London  is  as  low  as  the  death  rate  among  the  w^hites 
in  the  city  of  Washington,  and  lower  than  the  average  death  rate  in 
Washington,  although  London  is  the  largest  city  in  the  world.  This 
has  been  due  largely  to  the  vigorous  work  in  hygiene  undertaken 
by  the  London  county  council,  including  educational  means.  A 
short  time  ago  T  had  a  little  correspondence  with  ISIr.  John  Burns 
in  regard  to  the  matter.  He  is  a  particularly  well-posted  man  on 
the  subject,  because  he  has  taken  so  much  interest  in  it.  You  know 
that  he  was  himself  originally  a  labor  man  and  is  now  secretary  for 
municipal  government  and  has  made  a  particular  study  of  tubercu- 
losis and  of  alcohol. 

In  his  reply  to  my  question  as  to  what  in  his  opinion  had  caused 
this  wonderful  decline  in  the  death  rate  in  the  city  of  London,  he 
gave  a  number  of  reasons,  and  among  them,  and  emphasizing  it  more 
than  any  other,  was  the  reason  of  the  decline  in  the  consumption  of 
alcohol,  especially  among  the  working  classes.  He  believes,  and  T 
iDclieve,  and  I  believe  that  every  unbiased  student  of  the  subject 
believes,  that  one  of  the  very  worst  enemies  of  the  working  classes 
is  alcohol.  It  not  only  is  an  enemy  to  health,  but  it  is  an  enemy  to 
thrift  and  to  economic  well  being.  These  two  act  and  react  on  each 
other,  because  if  you  undermine  the  health  you  take  away  the  earn- 
ing power.  iVlcohol  is  one  of  the  chief  causes  of  tuberculosis.  That 
is  to  say,  it  is  one  of  the  chief  predisposing  conditions. 

Every  well-educated  expert  in  tuberculosis,  I  think,  agrees  that 
that  is  true.  A  generation  ago  they  would  not  have  believed  that 
whisky  was  not  a  good  thing  for  consumption,  but  now  every  well- 
educated  expert  in  tuberculosis  believes  that  alcohol  is  a  predispos- 
ing cause.  In  that  way  it  must  have  caused  a  great  effect  in  increas- 
ing consumption  among  the  working  classes,  where  consumption  is 
more  predominant  than  in  any  other  class,  and  therefore  responsible 
for  a  large  amount  of  the  death  rate  there  and  the  inability  to  work, 
because  there  is  nothing  that  robs  a  working  man  of  working  power 
so  much  as  tuberculosis.  So  on  either  end  \t  injures  the  health  of  the 
workman.  By  injuring  his  earnings  it  injures  both  his  health  and 
his  economic  well  being. 

I  know  that  John  Burns  is  right  in  the  belief  that  the  consumption 
of  alcohol  has  gone  down  in  Great  Britain,  for  only  a  month  ago  I 
believe  there  was  an  elaborate  article  on  the  consumption  of  alcohol 
in  Great  Britain  published  in  the  Journal  of  the  Royal  Statistical 
Society,  the  great  statistical  journal  of  the  world,  and  it  shows  a  de- 
cline in  the  consumption  of  alcohol  in  Great  Britain,  and  in  the  city 
of  London,  and  it  has  been  very  striking,  similar  to  the  decline  in 
Sweden,  and  has  been  coincident  with  this  gi-eat  decline  in  the  death 
rate. 

The  insurance  companies  have  taken  up  the  fight  against  alcohol. 
The  insurance  companies  which  are  going  into  public  health  ques- 
tions are  teachiiis:  their  risks  in  re.c:ard  to  alcohol.    When  the  Postal 


SALE   OF   INTOXICATING   LIQUORS.  7 

Life  Insurance  Co.  a  generation  ago  first  took  up  the  statistices  of 
this  country  and  tried  to  compare  the  mortality  between  those  who 
were  total  abstainers  and  those  who  were  not,  they  found  that  those 
who  were  total  abstainers  had  the  highest  mortality.  This  fact  was 
greeted  with  glee  by  the  users  of  alcohol,  but  it  turned  out  to  be  due 
to  the  fact  that  the  insurance  or  nuitual  benefit  societies,  which  con- 
sisted of  those  who  did  not  consume  alcohol,  were  a  select  class^ 
namely,  they  were  the  reformed  drunkards,  and  they  were  people  who 
were  just  about  to  die  anywa}^  and  therefore  their  mortality  was  very 
great.  It  was  due  to  alcohol,  not  due  to  lack  of  alcohol.  Within  the 
last  generation,  when  we  have  had  a  set  of  people  coming  in  who 
were  total  abstainers  early  in  life,  the  opposite  is  true,  so  that  now 
you  find  for  the  Golden  Sceptre,  and  other  societies  consisting  of 
total  abstainers,  the  death  rate  among  them  is  less  than  the  average. 
I  recently  saw  the  statistics  of  the  New  York  Life  Insurance  Co.  in 
reference  to  these  matters,  and  they  confirm  the  facts  I  have  recited. 

There  are  a  number  of  other  facts  that  I  might  give  if  I  had  my 
memoranda  here,  and  if  the  committee  would  like  to  ask  questions 
I  shall  be  very  glad  to  explain  in  further  detail  anything  I  have  said, 
or  to  answer  any  objections,  so  far  as  I  am  able  without  preparation 
or  notes. 

Senator  Works.  Professor,  if  you  have  statistics  in  convenient 
form  on  that  subject  that  you  would  be  willing  to  furnish  the  com- 
mittee, and  will  do  it  within  a  few  days,  we  should  be  very  glad  to. 
have  them. 

Prof.  Fisher.  I  think  I  could  send  them  here  within  a  week. 

The  Chairmajs.  We  will  withhold  the  printing  of  this  record  for 
at  least  a  week.  If  you  will  send  the  statistics  we  will  put  them  in 
the  record.  If  there  are  any  suggestions  that  occur  to  you  afterwards 
that  you  think  will  be  of  benefit  you  can  add  them  to  your  statement. 

The  following  was  subsequently  submitted  in  writing  by  Prof. 
Fisher : 

The  Relation  of  Alcohol  to  Health. 

[By  Irving  Fisher,  president  of  the  Committee  of  One  Hundred  on  National  Health.] 

As  a  statistician  and  economist,  I  have  made  studies  during  the  last  10  years  which 
have  led  me  to  the  conclusion  that  while  many  false  and  exaggerated  statements  have 
been  made  on  the  evils  of  alcohol  its  general  condemnation  by  scientists  of  late  has 
not  been  too  strong. 

All  physiologists  agree  that,  in  large  quantities  at  least,  alcohol  is  a  poison.  Dr. 
William  H.  Welch,  professor  of  pathology  at  Johns  Hopkins  University,  in  Baltimore^ 
is  quoted  '  as  saying  that  alcohol  in  sufficient  quantities  is  a  poison  to  all  living  organ- 
isms, both  animal  and  A'egetable.  The  present  state  of  physiological  science  indicates 
that  if  there  exists  any  "physiological  minimum"  of  alcohol  which  is  harmless  or 
beneficial  it  is  exceedingly  small.  The  best  statistics  indicate  that  even  "moder- 
ate" users  are  injured  thereby. 

MUSCULAR   ENDURANCE. 

Dr.  L.  Schnyder,^  of  Berne.  Switzerland,  shows,  by  means  of  strength-testing 
machines,  that  the  use  of  alcohol  diminishes  muscular  power.  A  striking  loss  of 
muscular  endurance  from  the  use  of  alcohol  was  also  shown  by  diagrams  of  ergographic 
experiments  exhibited  at  the  Dresden  International  Hygiene  Exhibition  in  1911. 

Careful  experiments  with  alcohol  in  relation  to  fatigue  have  been  reported  by 
Rivers,^  who  shows  that  alcohol  diminishes  the  capacity  for  exertion.     Experiments 

1  Bv  Henry  Smith  AVilliams,  M.  D.,  LL.  D.,  in  his  article  on  "Physiological  Effects  of  Alcohol,"  pub- 
lished in  McClure's  Magazine,  and  reprinted  in  The  Passing  of  the  Saloon,  compiled  by  George  M.  Ham- 
mell,  D.  D.,  Cincinnati  (Tower  Press). 

2  Alcohol  and  Muscular  Force,  bv  Dr.  L.  Schnvder.  in  a  compilation  on  the  subject  of  alcohol  by  J. 
Stump  (teacher  at  the  Hofwill  Semfnarv),  Zollikofen.  and  Robert  Willenegger,  Zurich,  Switzerland. 

3  W.  n.  R.  Rivers,  Influence  of  Alcohol  on  Fatigue,  etc.    London,  Edward  Arnold,  1908,  pp.  89-90. 


8  SAT.E    OF   INTOXICATING  LIQUORS. 

carried  on  by  Prof.  Aschaffenburg  with  four  typesetters,  all  users  of  alcohol,  showed 
that  on  days  when  Greek  wine,  containinj^  18  per  cent  of  alcohol,  was  given  to  the 
men  there  was  considerable  diminution  of  the  capacity  for  work.  On  the  alcohol  days 
two  of  the  men  did  decidedly  less  work,  while  the  work  of  the  remaining  two  was 
marked  by  great  irregularity. 

Not  only  endurance  of  exertion,  but  of  exposure  to  extremes  of  temperature,  is  weak- 
ened by  alcohol.  It  used  to  be  a  common  impression  that  alcohol  "warms  you  up  " ; 
consequently  explorers  and  sea  captains  usea  it.  A  more  careful  investigation  has 
shown  that  this  is  not  true,  and  now  the  opinion  is  exactly  the  opposite.  Amundsen, 
in  hie  expedition  to  the  South  Pole,  used  no  alcohol  except  when  in  winter  quarters. 
Grog  "was  used  as  a  'treat'  every  Saturday  night,  but  when  sledging  we  considered  it 
advisable  to  carry  no  spirits." 

That  alcohol  increases  fatigue  is  now  commonly  recognized  by  athletes.  "Alcohol 
gives  no  resistant  increase  of  muscular  power.  It  is  well  understood  by  all  who  con- 
trol large  bodies  of  men  engaged  in  physical  labor  that  alcohol  and  effective  work  are 
incompatible."^  It  is  interesting  to  know  that  when  the  bicycle  craze  was  at  its 
height  in  this  country  it  reduced  the  consumption  of  alcoholic  drinks  among  athletes, 
for  those  who  were  trying  to  make  their  century  runs  demanded  temperance  drinks. 

The  following  quotation  from  an  article  by  a  competent  authority,  Dr.  Richard  C. 
Cabot,  of  Boston,  is  taken  from  a  bulletin  ■^  issued  by  the  l\Ietropolitan  Life  Insurance 
Co.  for  the  education  in  hygiene  of  its  8,000,000  policy  holders.  It  is  significant  as 
showing  the  attitude  of  the  great  life  insurance  companies  toward  alcohol: 

"If  a  man  wishes  to  become  an  athlete  and  to  go  into  training  the  first  thing  his 
trainer  would  tell  him  would  be  to  cut  out  alcohol  absolutely.  In  fact,  no  trainer 
would  undertake  to  train  a  man  unless  he  was  willing  to  follow  this  rule." 

THE   LABORING   MAN. 

In  the  same  bulletin  Richard  Wright,  of  Cambridge,  points  out  the  great  importance 
of  abstinence  from  alcohol  to  the  laboring  man.  The  recognition  that  alcohol  inca- 
pacitates for  work  and  increases  the  danger  of  accidents  (which  may  be  disastrous 
not  only  to  the  employee  but  to  others,  as  in  the  case  of  locomotive  engineers)  has 
led  to  the  repre.ssion  of  the  use  of  alcohol.  Employers  are  beginning  to  understand 
that,  on  the  subject  of  alcohol  at  least,  the  interests  of  the  employer  and  the  employee 
are  identical.  In  fact,  one  of  the  great  causes  for  the  reduction  of  alcohol  in  recent 
years  has  been  the  fact  that  the  employer  has  found  it  to  his  financial  interest  to 
require  total  abstinence  of  his  workmen.  Dr.  Grenfell,  the  missionary  among  the 
Labrador  fishermen,  says:  "\\Tiy  don't  I  want  to  see  liquor  used  at  sea?  Because, 
when  I  go  down  for  a  watch  below,  I  want  to  feel  that  the  man  at  the  wheel  sees  only 
one  light  when  there  is  only  one  light  to  see." 

It  has  been  reported  that  the  New  York  Central  Railroad,  the  Lackawanna,  the 
Pennsylvania,  the  Baltimore  &  Ohio,  the  Wabash,  the  Rock  Island,  and  the  Great 
Northern  have  prohibited  the  use  of  intoxicants  by  employees  while  on  duty;  also 
that  the  LTnited  States  Department  of  Commerce  and  Labor  sent  circulars  to  the 
larger  employers  throughout  the  country  to  obtain  information  concerning  their 
attitude  in  regard  to  the  use  of  liquor  by  employees  and  received  replies  from  1,794 
establishments,  which  showed  that  the  use  of  intoxicating  liquors  was  forbidden 
either  in  whole  or  in  part. 

I  understand  also  that  the  United  Mine  Workers  of  America  have  recently  shut 
out  saloon  keepers  and  bartenders  from  membership  in  that  organization.  It  is  not 
surprising  to  find  that  labor  leaders  are  beginning  to  appreciate  the  importance  of 
the  subject.  This  is  true  particularly  in  England.  One  of  the  best  and  latest  sta- 
tistical documents  in  regard  to  the  recent  decline  in  the  consumption  of  alcohol  and 
its  causes  is  that  by  George  B.  Wilson  on  Variations  in  the  Consumption  of  Intoxi- 
cating Liquors,^  in  which  he  says: 

"The  rise  of  the  great  teetotal  friendly  societies,  the  Independent  Order  of  Rech- 
abites  and  the  Sons  of  Temperance,  is  but  an  indication  of  a  marked  change  in  the 
attitude  of  the  working  classes  to  this  question.  *  *  *  The  attitude  also  of  the 
leaders  of  the  Labor  Party,  who  are  not  merely,  in  the  great  majority  of  cases,  personal 
abstainers,  but  also  strong  advocates  among  the  workers  of  total  abstinence,  has  been 
an  important  factor.  *  *  *  The  growth  of  this  great  army  of  total  abstainers 
among  the  working  classes  from  177,000  in  1890  to  640,000  in  1910  is  a  significant 

I  The  Liquor  Problem:  A  Summary,  report  of  the  sulicommittee  of  Committee  of  Fifty  on  Physiologicftl 
Aspects  of  the  Liquor  I'roblem.    New  York  (Iloughton-Milllin  ),  1!105. 
3  Vol.  2"),  No.  11. 
» Journal  of  the  Royal  Statistical  Society,  Vol.  LXXV,  Part  II,  January,  1912. 


SALE    OF   INTOXICATING   LIQUORS. 


9 


indication  of  the  change  that  is  in  proore.s.^,  and  it  is  beyond  doubt  that  the  working- 
man  who  'drinks'  loses  caste  among  his  fellows  to  a  far  greater  extent  than  he  would 
1  have  done  20  years  ago." 


MENTAL   FITNESS. 


Dr. 


Alcohol  decreases  the  capacity  not  only  for  physical  but  also  for  mental  work. 
Cabot  states: ' 

"While  alcohol  affects  the  body,  the  greatest  harm  done  by  it  is  to  the  mind  and 
brain.  The  constant  use  of  alcohol  is  bad  for  the  stomach  and  liver.  But  these  effects, 
while  distinctly  harmful,  are  relatively  unimportant  as  compared  with  the  influence 
of  alcohol  on  the  mind  and  brain. ' ' 

Dr.  A.  Smith  shows,  by  elaborate  tables,  that  alcohol  tends  to  diminish  the  ability 
to  memorize  figures.^  These  and  other  data^  show  that  the  number  of  mental  errors, 
such  as  in  adding  figures,  etc.,  made  by  users  of  alcohol  is  very  much  greater  than  the 
number  made  by  abstainers.  A  subcommittee  of  the  committee  of  50,  appointed  to 
investigate  the  liquor  problem,  states:  * 

"Experiments  made  on  the  effect  of  the  continued  daily  administration  of  40  to  80 
grams  of  alcohol  show  a  decrease  after  a  few  days  in  the  ability  to  memorize  and  to  add 
figures.     This  depression  disappears  rapidly  on  leaving  off  the  alcohol. " 

The  effects  of  beer  and  wine  on  mental  faculties  was  tested  by  Bayer  in  Vienna,  who 
made  observations  on  591  public-school  children,  who  were  ranked  by  their  teachers 
in  three  groups — "good,"  fair,  "and  "poor."  The  results  of  these  observations  are 
given  in  the  following  tables:* 


Total,  591  pupilj. 

134  were 
total  ab- 
stainers. 

164  drank 
alcohol 
seldom. 

219  drank 

beer  and     71  drank  it 
wine  once  ;  twice  daily, 
daily. 

3  drank  it 
thrice  daily. 

Good..                           

Per  cent. 
42 
49 
9 

Per  cent. 
34 
57 
9 

Per  cent.    1    Per  cent. 
28                  25 
58                   58 
14                  18 

Per  cent. 

Fair.      .                      -   

33 

Poor .... 

67 

E.  Ivi-aepelin,  professor  at  the  Universitat  Heidelberg,  also  tells  us  that  alcohol 
diminishes  rapidity  in  adding  figures. 

INSANITY. 

It  is  well  known  that  alcohol  is  a  potent  cause  of  insanity.  Kraepelin  further  tells 
us®  that  10  to  30  per  cent  of  all  mental  illness  is  due— in  part  at  least — to  alcohol, 
and  that  the  male  sex  shows  at  least  10  times  as  ^eat  a  frequency  of  alcohohc  insanity 
as  the  female.  We  are  told  by  Dr.  Frederick  Peterson,  president  of  the  New  York 
State  ("ommission  in  Lunacy,  "that  ''In  the  State  of  New  York  there  are  now  some 
30,000  insane  persons  in  public  and  private  hospitals.  It  is  believed  that  about  one- 
fifth  of  them,  or  6,000  patients,  owe  their  insanity  to  alcohol  used  either  by  themselves 
or  by  their  parents.  In  the  asylums  of  the  United  States  there  are  150,000  insane 
people,  and,  if  we  take  the  same  proportions  as  before,  there  are  30,000  persons  in 
this  country  whom  alcohol  has  made  or  has  helped  to  make  insane.  *  *  *  Dr. 
Macdonald,"  who  is  one  of  the  greatest  specialists  on  insanity  w^e  have  in  this  country, 
thinks  that  one  insane  person  causes  a  loss  to  the  State  of  nearly  $400  a  year.  The 
total  loss  in  monev  to  the  State  of  New  York  caused  through  alcohohc  insanity  must 
therefore  be  $2,400,000  and  the  United  States  $12,000,000  every  year."^ 


CRIME. 


Crime  is  usually,  if  not  always,  a  manifestation  of  mental  aberration — temporary  or 
chronic— and  this  mental  aberration  is  in  a  great  number  of  cases  due  to  alcohol.  The 
Massachusetts  Bureau  of  Labor  investigations  showed  that  "84.41  per  cent  of  all  the 


1  JournBl  of  the  Royal  Statistical  Society,  Part  II,  January,  1912. 
-  Table  Bl,  in  compilation  by  J.  Stump,  loc.  cit. 
3  Bv  J.  Joss,  in  compilation  bv  J.  Stump,  loc.  cit. 

*  Physiological  Aspects  of  the"  Liquor  Problem,  Vol.  II,  edited  by  John  S.  BiUmgs,  Boston  (Houghton- 
Mifflin),  1903. 
s  Taken  from  Physiological  Effects  of  Alcohol,  loo.  cit. 
«  Psychiatrie,  Leipzig  (Barth),  1899. 
'  In  "the  Metropolitan,  loc.  cit. 


10  SALE   OF   INTOXICATING   LIQUOES. 

26,672  crimes  [for  wliicli  lliere  were  convictions  in  Massachusetts  in  1895]  were  due 
to  intemperate  habits,  and  82  per  cent  were  committed  while  the  criminal  was  under 
the  influence  of  liquor."  '  The  late  Edward  Everett  Hale,  a  lifelong  observer  of 
social  conditions,  is  reported  as  saying: 

"If  anybody  will  take  charge  oi'  all  Boston's  poverty  and  crime  which  results  from 
dnnikenness,  the  South  Congregational  Church,  of  which  1  have  the  honor  to  be  the 
minister,  will  alone  take  charge  of  all  the  rest  of  the  poverty  which  needs  relief  in  the 
city  of  Boston.'" 

Richard  Wright  states: 

"Dr.  Stehr's  chart  confirms  scientifically  what  has  long  been  generally  kno^\^l,  that 
accidents  and  crimes  of  violence  increase  rapidly  with  the  drinking  of  alcohol.  This 
is  why  Sweden  stopped  the  sale  of  alcohol  during  the  recent  strike  in  that  country, 
and  San  Francisco  and  Chelsea  shut  up  their  saloons  during  the  earthquake  and  fire."^ 

The  general  conclusions  of  the  committee  of  50  after  its  investigation  which  cov- 
ered a  period  of  three  years,  carried  on  under  the  general  direction  of  Prof.  Henry  W. 
Famam,  of  Yale  University,  were  that  liquor  was  a  first  cause  in  31  per  cent  of  the 
criminals  studied,  and  that  it  entered  in  as  a  cause,  directly  or  indirectly,  in  50  per  cent. 
Mr.  Samuel  J.  Barrows  states^  that  "of  30,000  prisoners  examined,  *  *  *  41  p^ 
cent  committed  their  crime  under  the  influence  of  alcohol.  In  Belgium  Prof.  Thiry 
makes  the  general  proportion  45  per  cent." 

Although  police  convictions  are  not  a  perfect  indication  of  the  use  of  alcohol,  but 
often  merely  an  indication  of  the  vigilance  and  spirit  of  the  police,  they  are  neverthe- 
less of  some  value,  especially  in  England,  where  the  administration  of  the  law  is  less 
variable  than  in  this  country.  George  W.  Wilson  states^  that  "there  is  a  real  connec- 
tion between  the  variations  in  the  consumption  of  intoxicating  beverages  in  the 
United  Kingdom  and  the  variations  in  the  number  of  proceedings  and  con\'iction3  for 
offenses  connected  mth  intoxication." 

Temperance  reform  almost  invariably  leads  to  a  reduction  in  crime.  The  prisoi 
commissioners  for  Scotland  are  quoted  by  Wilson  *  as  showing  that  "There  can  ben4 
doubt  that  there  is  less  intemperance  in  the  country;  the  change  perhaps  not  ^erJ 
perceptible  among  the  class  who  are  habitually  or  very  frequently  intoxicated, bul 
it  is  noticeable  in  the  great  reduction  of  crime  and  offenses  by  persons  who  occasionally 
become  intoxicated  and  then  commit  crimes  and  offenses  of  all  kinds. " 

SOCIAL   EVIL. 

Alcohol  leads  not  only  to  crime,  but  to  vice.  This  effect  also  may  be  regarded  as" 
due  to  alcohol  by  producing  an  abnormal  state  of  mind.  The  dean  of  the  Yale  Medical 
School,  at  a  meeting  in  New  Haven,  Conn.,  March  11,  1911,  stated  that  young  men 
usually  go  astray  morally  under  the  influence  of  alcohol.  Forel  ^  says  that  one  can 
scarcely  expect  to  make  successful  headway  against  the  social  evil  unless  at  the  same 
time  an  uncompromising  fight  is  waged  against  alccihol.  An  official  in  the  office  of 
the  district  attorney  in  New  York  reports  that  the  houses  of  prostitution  would,  in 
many  cases,  probably  not  be  able  to  exist  were  it  not  for  the  sale  of  alcohol  in  them 
And  it  is  even  more  certain  that  their  patronage  would  be  greatly  reduced  were  it  not 
for  the  custom  of  using  alcohol  as  a  beverage  in  the  community  generally. 

Anything  which  diminishes  the  consumption  of  alcohol  has  been  shown  to  diminish 
the  social  evil.  In  this,  as  in  other  ways,  hygiene  and  morals  are  intimately  related^ 
the  relation  being  primarily  a  physiological  one;  for  alcohol  not  only  produces  abnor- 
mal desire,  but  reduces  the  strength  of  will  by  which  such  desire  is  resisted.' 

DEGENER.\TIOX. 

The  influence  of  alcohol  on  physical  degeneration  was  recognized  by  the  British 
parliamentary  committee  on  race  degeneration  in  that  country.  The  report  of  that 
committee  *  showed  that  they  considered  alcoholic  stimulants  harmful  to  the  race. 
Dr.  T.  D.  Crothers,  of  Hartford,  Conn.,  states  that  "There  are  to-day  over  a  million 
unrecognized  inebriates  who  are  the  most  defective,  dangerous,  and  degenerate  of 

'  What  People  Have  Said  About  Whisky,  loc.  cit. 

2  From  The  Metropolitan,  loc  cit. 

3  "The  temperance  tidal  wave,"  in  the  Outlook,  vol.  89,  Xo.  10,  July  4,  190S,  p.  515. 
*  Loc.  cit. 

'  Loc.  cit.,  p.  239. 

'  Tlie  Se.xual  Question,  by  August  Forel,  M.  D.,  Ph.  D.,  LL.  D.,  formerly  Professor  of  Psychiatry  at  and 
Director  of  the  Insane  Asylum  m  Zurich,  Switzerland.    New  York  (Rebnab  Co). 

'  The  harmful  effect  of  alcohol  on  sexual  life  is  described  by  Dr.  Gerhard  Hahn  in  chapter  9  of  Das  Ge- 
schlechtsleben  des  Menschen.    Leipzig  (Barth),  1911. 

8  Report  of  the  Inter-Dcpartmental  Committee  on  Physical  Deterioration.  Vol.  1,  London  (Wa\nnau  ic 
Sons),  1904. 


SALE    OF   INTOXICATING   LIQUORS.  11 

all  classes."''  A  series  of  statistics  collected  by  J.  Stump-  show  a  close  relation 
between  alcohol  and  degeneration,  insanity,  criminality,  idiocy,  physical  defects,  etc. 
Statistics  given  at  the  Dresden  International  Hygiene  Exhibition  showed  that  users  of 
alcohol  have  three  and  one-fourth  times  as  many  bad  teetli  as  abstainers.  Dr.  Frederick 
Peterson  reports  ^  that  out  of  2,500  idiots,  epileptics,  and  imbeciles  admitted  to  a  certain 
hospital,  over  41  per  cent  had  drunken  parents,  and  Dr.  Crothers  gives  figures*  to  show 
that  over  50  per  cent  of  all  inebriates  and  alcoholics  conie  from  inherited  degenera- 
tions, and  are  literally  the  expression  of  transmitted  defects.  It  is  fair  to  say,  liow- 
ever,  that  while  degeneration  may  lead  to  alcoliolism,  tliere  is  no  convincing  evidence 
that  alcoholism  leads  to  inlierited  degeneration.  In  fact,  some  scientihc  investiga- 
tions of  the  Galton  Laboratory  for  Eugenics,  at  University  College,  London,  tend  to 
show  that  no  such  inlieritance  exists 

ILLNESS. 

But  however  true  or  untrue  it  may  be  that  inabilities  due  to  alcohol  are  transmitted 
from  parents  to  child,  certain  it  is  that  alcohol  actually  produces  such  inabilities  in 
the  individual.  As  Metchnikoff  points  out,  alcohol  predisposes  to  disease;  "it  lowers 
the  resistance  of  the  white  corpuscles,  which  are  the  natural  defenders  of  the  body. 
It  is  well  known  that  people  who  indulge  too  freely  in  alcohol  show  far  less  resistance 
to  infectious  diseases  than  abstemious  individuals."  *  The  late  Sir  Andrew  Clark,  the 
great  London  physician,  said: 

"I  am  speaking  solemnly  and  carefully  in  the  presence  of  truth,  and  I  tell  you  that 
I  am  considerably  within  the  mark  when  I  say  to  you  that,  going  the  round  of  my  hos- 
pital wards  to-day,  seven  out  of  every  ten  owed  their  ill  health  to  alcohol."^ 

"Statistics  of  English  sick  benefit  societies — the  Sons  of  Temperance,  Odd  Fellows, 
and  Foresters — show  a  remarkal^le  superiority  of  abstainers  over  users  of  alcohol," 
according  to  J.  Stump; ^  "in  respect  to  frequency  of  illness,  the  illness  of  the  abstain- 
ers is  about  half  that  of  the  users  of  alcohol,  and  for  those  between  55  and  65  years 
of  age  less  than  one-fifth."  A  basis  for  computing  the  sickness  that  might  be  saved 
by  total  abstinence  and  nonabstaining  societies  was  made  by  Mr.  H.  Dillon  Gouge, 
public  actuary  of  South  Axistralia,  in  1892.  He  found  that  the  average  weeks  of  sick- 
ness in  three  societies  of  abstainers  was  1,248;  in  three  societies  of  nonabstainers  the 
average  weeks  of  sickness  was  2,317  (lacking  only  one-sixth  of  being  twice  as  much). 
Metchnikoff  states : 

"According  to  the  careful  investigations  of  a  Swedish  doctor,  Edgren,  published  in 
his  '  Monograph  on  Arterial  Sclerosis,'  one  case  in  every  five  of  this  disease  is  caused  by 
syphilis,  and  he  shows  that  chronic  alcoholism  is  an  even  more  frequent  cause  (25  per 
cent).  These  two  factors,  when  united,  are  responsible  for  nearly  half  (45  per  cent) 
the  cases  of  arterial  sclerosis  that  occur."  ^ 

TUBERCULOSIS. 

That  alcohol  is  predisposing  to  tuberculosis  is  stated  by  Drs.  Knopf,  Flick,  Huber, 
and  other  authorities.  It  was  also  shown  by  the  exhibit  of  the  German  central  com- 
mittee for  the  prevention  of  tuberculosis.*  Dr.  Crothers  states:^  "Statistics  of  con- 
sumptives show  that  a  very  large  proportion  of  these  were  spirit  and  beer  drinkers 
in  the  early  stages,  with  marked  symptoms  of  dyspepsia,  faulty  nutrition,  and  ex- 
haustion." The  International  Congress  on  Tuberculosis,  at  Paris,  in  1905,  passed  a 
resolution  "That,  in  view  of  the  close  connection  between  alcoholism  and  tuberculosis, 
this  Congress  strongly  emphasizes  the  importance  of  combining  the  fight  against 
tuberculosis  with  the  struggle  against  alcoholism." 

MORTALITY. 

Alcohol  is  not  only  responsible  for  a  vast  amount  of  physical  and  mental  and  moral 
infirmities  and  abnormalities,  inefficiency,  invalidity,  illness,  insanity,  degeneration, 
with  resulting  misery,  vice,  and  crime,  but  in  many  cases  it  directly  causes  death 
and  in  others  indirect^^  contributes  to  the  cause  of  death.  This  has  been  true  to  the 
extent  of  exterminating  certain  races.    We  have  a  well-known  example  in  the  case  oi 


■<  "The  Sanitary  Side  of  the  Drink  Problem." 

2  Loc.  cit. 

3  "Alcohol  and  the  child's  heritage,"  The  Metropolitan,  loc.  cit. 

*  "Some  Distinct  Psvchoneiiroses  common  to  all  cases  of  Incbrictv  and  Alcoholism." 

6  The  New  Hygiene,by  Elie  MctchnikofT,  Chicago  (Keener),  1906. 

6  What  People  Have  Said  About  ^^'hislvv,  loc.  cit. 

'  The  Nature  of  Man,  bv  Elie  Metchnilvotf,  New  York  (G.  P.  Putnam's  Sons),  190.3. 

8  In  their  catalogue  entitled  "Guidedu  Mus6e  Ambulant  de  la  Tnberculose,"  published  by  Dr.  Klehmet. 

s  "Tuberculosis  Due  to  Toxfemic  State." 


12  SALE   OF   INTOXICATING  LIQUOES. 

the  American  Indians.  The  same  inlluonce  which  ihey  felt  in  extreme,  the  whitp 
men,  with  a  more  moderate  use  of  alcohol,  still  suffers,  but  in  a  more  moderate  deut- -. 
Sir  Victor  Uorsleyaud  .Mary  D.  Sturge,  M.  D.,'  show  that  liquor  sellcrshave  a  mortality 
62  per  cent  higher  than  the  average  mortality  of  adult  males,  while  abstainers  are  44 
per  cent  lower  than  the  average.^  J.  Stump's  figures  ^  show  that  the  abstainers  have 
a  mortality  only  three-fourths  as  great  as  that  of  the  nonabstaiuers.  His  statistics  of 
the  United  Kingdom  Temperance  and  General  Provident  Institution,  applying  to 
over  31,000  users  of  alcohol  and  over  29,000  abstainers,  and  covering  a  period  of  60  years 
from  1841  to  1901,  show  that  the  mortality  from  alcohol  users  is  greater  than  that  of 
abstainers  at  practically  every  age  of  life,  the  excess  being  least  after  70  years  of  age, 
and  greatest  between  the  ages  of  35  and  40,  at  which  time  the  mortality  from  alcohol 
users  is  almost  double  (82  per  cent  greater  than)  the  mortality  of  abstainers. 

Since  the  hguros  of  the  Mutual  Life  Insurance  Co.  of  New  York  ■*  give  the  same  advan- 
tage to  American  abstainers  (23  per  cent  lower  death  rate),  it  seems  fair  to  take  the 
available  computations  of  the  English  life  insm'ance  companies  as  a  basis  for  esti- 
mating the  saving  of  life  that  would  result  in  the  United  States  if  we  should  all  decide 
to  give  up  the  use  of  alcohol.  Of  course,  however,  it  should  be  remembered  that  the 
favorable  figure  of  total  abstainers  is  partly  due  to  the  fact  that  as  a  class  they  practice 
personal  hygiene  in  all  its  forms. 

The  committee  of  the  Harveian  Society  of  London,  appointed  in  1879,  says:  ^ 

"We  find,  therefore,  upon  the  whole,  reason  to  think  that  in  the  metropolis  the  mor- 
tality among  any  considerable  group  of  intemperate  persons  will  differ  from  that  gen- 
erally prevailing  among  adults  in  the  following  important  particulars,  viz:  A  fom-fold 
increase  iu  the  deaths  from  diseases  of  the  liver  and  chylopoietic  viscera;  a  twofold 
increase  in  the  deaths  from  disease  of  the  kidney,  a  decrease  half  as  much  again  in 
those  from  health  disease,  a  marked  increase  in  those  from  pneumonia  and  pleurisy, 
a  considerable  increase  and  an  earlier  occurrence  of  those  from  disease  of  the  central 
nervous  system;  a  marked  decrease  of  those  from  bronchitis,  asthma,  emphysema, 
and  congestion  of  lungs,  a  decrease  nearly  as  great  in  those  from  phthisis,  and  a  later 
occurrence,  or  at  least  termination,  of  the  disease;  a  very  large  decrease  in  those  from 
old  age,  with  an  increase  of  those  referred  to  atrophy,  debility,  etc.,  and  the  addition 
of  a  considerable  group  referred  in  general  terms  to  alcoholism,  or  chronic  alcohol- 
ism, or  resulting  from  accidents." 

Newsholme  states :  ^ 

"So  far  it  can  be  stated  with  a  high  degree  of  probability  that  over  6,000  deaths  of 
men  are  annually  caused  in  England  and  Wales  by  diseases  induced  by  alcoholic 
indulgence.  For  every  100  such  deaths  among  men  there  are,  according  to  the 
English  experience,  81  among  women.  It  is  evident,  therefore,  that  nearly  11,000 
deaths  were  probably  caused  in  England  and  Wales  in  1904  by  the  two  conditions^ 
which  can  with  certainty  be  ascribed  to  alcohol.  This  means  that  about  5  per  cent 
of  the  total  deaths  in  adults  are  caused  by  alcohol.  This  percentage  probably  very; 
greatly  understates  the  real  facts." 

The  best  authority  on  the  subject  of  the  mortality  of  alcohol  users  in  this  country  is  I 
undoubtedly  Mr.  Edward  Bunnell  Phelps.     In  his  book  ^  on  this  subject  he  shows  j 
that  the  male  deaths  in  the  area  of  the  United  States  for  which  we  have  accurate' 
registration  of  deaths,  between  the  ages  of  20  and  74,  inclusive,  12  per  cent  of  the' 
cases  of  tuberculosis  of  the  lungs  are  due  in  whole  or  in  part  to  alcohol;  16  per  cent  of 
the  deaths  from  heart  disease;  22  per  cent  of  the  deaths  from  pneumonia;  22  percent; 
of  the  deaths  from  paralysis;  22  per  cent  of  the  deaths  from  apoplexy;  23  per  cent  of 
the  deaths  from  suicide;  23  per  cent  of  the  deaths  from  diseases  of  the  arteries;  30  peri 
cent  of  the  deaths  from  Bright's  disease;  67  per  cent  of  the  deaths  from  cirrhosis  of  the 
liver;  and  100  per  cent  of  the  deaths  from  alcoholism.     There  are  also  deaths  from; 
accidents  and  other  causes  partly  due  to  alcohol.     Mr.  Phelps  also  states  ^  that  the 
net  results  of  an  effort  to  arrive,  by  means  of  a  statistical  investigation,  at  a  tentative 
approximation  of  the  mortality  of  alcohol  in  the  United  States  "indicate  that,  roughly  j 
speaking,  alcohol  may  have  been  directly  or  indirectly  responsible  for  about  66,000; 

1  In  Alcohol  and  the  Human  Body,  London  (Macmillan),  1908,  p.  350. 

2  These  comparisons  are  based  on  the  registrar  general's  return  and  the  experience  of  the  Independenj 
Order  of  KechalMtes  for  the  years  1878-1887. 

5  Loc.  cit. 

*  "  Efleet  of  total  abstinenee  on  the  death  rate,"  by  Joel  G.  Van  Cise,actuary  of  the  Equitable  Life  Assur 
ance  Co.  of  the  United  States. 

5  British  Medical  Journal,  Jan.  20,  1883,  p.  07,  quoted  by  Edward  Bunnell  Phelps  in  The  Mortality 
Alcohol,  New  York  (Thrift  Publishing  Co.),  1911. 

6  Taken  from  The  Mortality  of  Alcohoh  loc.  cit.  (p.  20),  where  it  was  introduced  as  follows: 
"  Dr.  Arthur  Newsholme,  one  of  the  foremost  statistical  authorities  in  Great  Britain,  and  a  cautious  and 

conservative  student  of  mortality  due  to  alcoholism,  states  in  a  composite  work  of  14  medical  authoritie| 
on  'The  Drink  Problem  in  its  Medico-Sociological  .\spects,'  edited  by  T.  N.  Kelyiiack,  M.  D.,  1907.'' 


SALE   OF   INTOXICATING   LIQUORS.  13 

deaths  in  continental  United  States  in  1908,  or  for  about  1  in  every  13  deaths  at  adult 
ages,  a  figure  equivalent  to  5.1  per  cent  of  tlie  total  mortality  from  all  causes  at  all 
ages."  He  shows,  further,  that  5.1  per  cent  of  the  total  mortality  at  all  ages  would  be 
about  7.7  per  cent  of  the  total  mortality  at  adult  ages.     He  says": 

''It  should  be  clearly  understood  that  this  figure  by  no  means  signifies  that  alcohol 
was  the  direct  cause  of  66,000  deaths,  the  number  in  question  presumably  including 
all  of  the  deaths  in  which  alcohol  played  any  appreciable  contributory  i)art."  ' 

Fi-om  what  has  been  said,  we  shouhl  expect  a  decline  in  the  death"  rate  to  follow  a 
reduction  in  the  use  of  alcohol.  This  turns  out  to  be  the  case.  The  following  diagram 
shows  the  decline  in  the  consumption  of  liquor  in  the  United  Kingdom  from  1890  to 
1909,  the  consumption  of  1890  being  taken  as  100  for  purposes  of  comparison. - 

John  Burns,  the  English  labor  leader  and  statesman,  a  very  capable  observer, 
intimately  acquainted  with  the  working  classes  and  with  statistics  concerning  them, 
has  stated  repeatedly  that  in  his  opinion  there  is  no  doubt  that  the  decline  in  the  death 
rate  is  partly  due  to  the  decline  in  the  use  of  alcoholic  beverages.  The  following  table 
shows  the  remarkable  decline  in  the  death  rate  per  1,000  of  population  in  London:  •' 

1890 21.1  1897 17.  g"  I  1904 16.5 

1891 21.  1  1898 18.  4  I  1905 15.6 

1892 20.3  1899 19.  5    1906 15.8 

1893 20.  9  1900 18.  6  I  1907 15.  3 

1894 17.4  1901 17.2     1908 14.6 

1895 19.  5  1902 17.  4    1909 15.0 

1896 18.  2!  1903 15.  4    1910 13.7 

There  has  been  a  fall  in  the  death  rate  almost  every  year,  and  many  other  causes 
besides  temperance  must  have  contributed  to  this  result.  It  is  interesting  to  observe, 
however,  that,  beginning  with  1900,  when  the  gi'eat  reduction  in  the  consumption  of 
alcohol  began,  the  fall  in  the  death  rate  has  been  more  than  twice  as  rapid  as  previously. 

The  history  of  alcohol  in  Sweden  is  especially  interesting,  for  the  reason  that  at 
one  time  Sweden  was  very  excessive  in  the  use  of  alcohcl.  This  was  especially  true 
after  1775,  when  Gustavus  III  introduced  a  State  monopoly  of  manufacturing  spirits 
for  the  purpose  of  securing  revenue.  This  system  operated  in  Sweden  at  that  time 
in  the  same  way  that  a  corresponding  system  now  operates  in  Russia.  In  Sweden 
then,  as  in  Russia  now,  the  people  were  actually  urged  to  increase  their  consumption 
of  spirits.  At  that  time  the  death  rate  in  Sweden  was  high,  and  it  remained  high  as 
long  as  this  system  of  putting  a  premium  on  the  use  of  alcohol  was  in  vogue.  The 
consumption  of  alcohol  increased  and  seems  to  have  reached  a  climax  in  about  the 
year  1830,  when  the  term  "drunken  Sweden  "  had  become  a  byword.  It  was  estimated 
that  the  consumption  of  alcohol  amounted  to  20  liters  of  pure  alcohol  per  capita  per 
year — nearly  five  times  the  present  consumption. 

Under  the  leadership  of  Peter  Weiselgren,  dean  of  Gothenburg,  a  strong  wave  of 
temperance  reform  set  in,  which  led  first  to  the  formation  of  a  public  sentiment  against 
alcohol  and  a  reduction  in  its  use,  and  later  to  the  reform  legislation  of  1855,  which 
resulted  in  a  still  further  reduction.  These  reforms  led  to  the  well-known  Gothen- 
burg system,  which  was  finally  perfected  a  decade  later.     Lender  this  system  the 

1  Mr.  Phelps  names  two  factors  which  explain  why  the  percentage  of  deaths  from  alcohol  is  probably 
greater  in  England,  as  sho^-n  by  the  Harveian  Society's  investigation,  than  in  the  United  States,  as  shown 
by  his  own.  These  two  factors  are:  First,  the  larger  percentage  of  rural  population  in  the  United  Stales  as 
compared  with  the  merely  urban  population  considered  by  the  Harveian  Society's  investigation;  second, 
the  much  higher  ratio  of  female  deaths  attributed  to  alcohol  by  the  Harveian  Society's  investigation, 
namely,  5  per  cent,  as  compared  with  17  per  cent.    Mr.  Phelps  goes  on  to  state: 

"Leaving  out  all  other  clearly  defined  differences  between  the  conditions  of  London  in  or  about  1880 
and  the  United  States  in  190S,  the  two  factors  named  fully  account  for  most,  if  not  all,  of  the  difference 
between  the  Harveian  Society's  assumed  raito  of  14  per  cent  and  this  investigation's  conclusion  of  7.7  per 
cent  as  indicative  of  the  proportion  of  all  deaths  at  adult  ages  directly  or  indirectly  due  to  alcohol  in  London 
in  1880  and  in  continental  United  States  in  190S. 

****** 

"In  conclusion,  it  would  seem  that  in  all  probability  the  approximate  total  of  66,000  deaths  assumed  to- 
be  the  mortahty  directly  or  indirectly  due  to  alcohol  in  this  country  in  the  year  1908  is  not  only  an  outside 
figure,  but  possibly  one  somewhat  in  excess  of  the  real  number  of  deaths  which  would  properly  be  so  charge- 
able if  there  were  any  means  of  measuring  the  actual  experience  of  the  Nation.  Apparently  not  more  than 
1  in  13  deaths  at  adult  ages  is  even  remotely  attributable  to  alcohol,  instead  of  the  1  in  6  deaths  at  all  ages 
which  Mr.  Reid  and  some  other  -nTiters  on  "the  subject  would  have  us  believe  are  so  chargeable.  The  con- 
clusions of  this  paper  have  been  reached  by  clearly  defined  statistical  processes,  everv  detail  of  which  may 
be  critically  examined  and  accepted  or  rejected,  whereas  practically  all  of  the  preceding  figures  of  the  last 
25  years  have  been  mere  generalizations.    Which  conclusions  are  fairly  entitled  to  the  greater  degree  of 

Cr6d.GIlC6?  '^ 

2  From  article  by  George  B.  "WOson  in  the  Journal  of  the  Royal  Statistical  Society,  loc.  cit. 

3  From  the  Registrar  General's  Annual  Summary  of  Marriages,  Births,  and  Deaths  in  England  and 
AV ales  and  in  London,  1910  (revised). 


14 


SALE    OF   INTOXICATING   LIQUORS. 


monopoly  of  selling  liquor  is  given  by  special  license  from  the  Government  to  a  par- 
ticular company  in  each  locality.  Those  who  obtain  this  license  are  limited  in  their 
profits  from  alcohol  to  Ihe  ordinary  interest  on  their  capital,  the  surplus  reverting 
to  the  State  for  public  purposes.  As  these  licensed  companies  also  sell  food,  they  have 
an  incentive  to  increase  their  sales  of  food  rather  than  of  alcohol,  as  the  sales  of  alcohol 
are  sub'ject  to  special  restrictions  and  systematically  discouraged,  just  as  a  century 
earlier  they  had  been  systematically  encouraged. 


1891 
1890 

1693 
1892 

1895 
1894 

1697 
(896 

(899 
1898 

190/ 
1900 

(903          /905 
»902          (904 

(907 
1906 

1909 
•906 

-f 

"•,, 

ff'' 

/ 

'••. 

• 
\ 

0*r        ., 

> 

■•-V.-. 

t 

\ 

\ 
\ 
\ 

\ 

\ 

'% 

■♦v 

\ 
\ 

/ 

p 
/ 

• 
* 

V 

•^ 

• 

• 
• 

\ 
• 

\ 

• 

• 

\ 
\ 
\ 

• 
• 

\ 
\ 

1 

\ 
\ 

\ 

• 

\ 

9 

\ 

• 

\ 

\ 
\ 

\ 

\ 

120 


i\5 


no 


105 


100 


95 


30 


55 


80 


75 


70 


6S 


60 

Fig.   1. — The  per  capita  consumption  of  beer,  spirits,   and  wine  in  the  United   Kingdom 
during  the  years  1890  to  1909,  reduced  to  the  standard  of  1890. 

The  first  effect  of  Swedish  temperance  reform  was  to  decrease  the  consumption  of 
spirits  and  increase  that  of  beer,  but  latterly  the  consumption  of  beer  has  also  de- 
creased, as  well  as  of  spirits  and  wines,  until  now  Sweden  is  one  of  the  smallest  users 
of  alcohol  of  the  nations  of  the  world,  and  temperance  sentiment  is  exceedingly  strong 
among  the  people,  especially  the  working  classes. 


I 


Liters. 

189G-1900 5. 1 

1901-1905 4.9 

1906-19 10 4.  4 


SALE    OF   INTOXICATING   LIQUORS.  15 

The  Rev.  Clarence  True  Wilson,  D.  D.,  stated  about  a  year  ap;o: ' 
"Particulars  regarding  the  remarkable  plebiscite  on  prohibition  recently  taken  in 
Sweden  illustrate  the  thorough  nature  of  the  agitation  in  that  Scandinavian  country. 
The  State  was  sown  almost  knee  deep  with  prohibition  tracts;  an  army  of  volunteer 
workers  were  enrolled;  and  the  question  was  stirred  in  every  church  and  chapel 
throughout  the  laud.  The  overwhelming  victory  for  prohibition  confirms  the  judg- 
ment of  a  well-known  writer  that  "Sweden  has  been  changed  in  a  few  generations 
from  one  of  the  drunkenest  countries  of  the  world  to  the  soberest  '  *  *  *  In  all 
the  country  parts  of  Sweden,  with  4,000,000  of  population,  there  are  at  present  only 
about  140  spirit  shops." 

The  following  table  shows  the  estimated  consumption,  in  terms  of  pure  alcohol, 
per  capita,  per  annum  :- 

Liters. 

1861-1870 5.  3 

1871-1880 6. 1 

1881-1890 4.  .5 

1891-1895 4.2 

It  is  interesting  to  observe  that  the  death  rate  in  Sweden,  while  its  decline  has 
been  under  the  combined  influence  of  many  other  mighty  factors  at  work  in  that 
country,  as  to  a  certain  extent  in  all  countries,  has  exhibited  at  least  an  apparent 
relation  to  the  consumption  of  alcohol.  During  the  period  when  Sweden  was  becom- 
ing increasingly  alcoholic  the  death  rate  showed  substantially  no  decline.  Since 
the  temperance  reform  was  undertaken  in  earnest,  in  the  middle  of  the  nineteenth 
century,  the  decline  of  the  death  rate  has  proceeded  with  great  rapidity,  until  now 
it  is  about  half  of  what  it  was  150  years  ago.  It  is  significant  that  the  decline  in  the 
mortality  in  Sweden  is  a  decline  at  all  ages — the  mortality  of  octogenarians,  for 
instance,  being  less  than  it  used  to  be.  This  is  not  true  of  most  other  countries, 
where  the  fight  to  lower  the  mortality  has  been  mostly  against  infectious  or 
epidemic  diseases,  instead  of  against  diseases  combatted  by  personal  hygiene.. 

The  figures  for  the  Swedish  death  rate  per  thou,sand  of  population  are  as  follows 

1751-1760 27.  4  1904 15.  3 

1801-1810 27.  9  1905 15.  6 

1851-1860 21.  7  '  1906 14.  4 

1891-1900 16.  4  1907 14.  6 

1901 16.1  1908 14.9 

1902 15.  4  1909 13.  7 

1903 15. 1  1910 14.  0 

The  death  rate  in  Sweden  is  now  the  lowest  of  any  country  in  the  world. 

"In  Sweden  the  House  of  Representatives,  by  a  vote  of  89  to  86,  declared  ir  1907 
approval  of  the  principle  of  prohibition,  which  was  put  into  effect  temporarily  through- 
out the  national  strike  from  the  4th  to  the  31st  of  August,  1909,  with  an  immensely 
beneficial  result.  Restam-ants  only  were  permitted  to  serve  wine  ard  beer  with 
meals.  The  mortality  in  Stockholm  for  the  8th  to  the  14th  of  August,  1909,  was  but 
8.7  pro  mille,  as  against  13.4  pro  mille  as  the  average  for  the  corresponding  days  in  the 
previous  10  years. 

"  Official  police  court  statistics  during  the  strike  show  that  at  Gothenburg,  in  August, 
1908,  there  were  847  arrests  for  drunkenness;  during  August,  1909,  but  113;  from  Sep- 
tember 1  to  September  7,  1908,  188  arrests;  September' 1  to  7,  1909,  only  3;  on  Sep- 
tember 8  the  public  houses  were  opened  again,  and  from  September  8  to  September  19 
there  were  259  arrests.  At  Stockholm,  in  August,  1908,  there  were  1,549  arrests  for 
drunkenness,  but  169  only  in  August,  1909;  at  Nykoping,  26  arrests  for  August,  1908; 
1  only  in  August,  1909.  Orebro  showed  100  police  court  cases,  84  of  which  were  for 
drunkenness,  in  August,  1908;  9  only,  and  none  for  drunkenness,  in  August,  1909.  At 
Malmo,  in  August,  1907,  346  arrests  for  drunkenness;  August,  1908,  443;  August,  1909, 
175,  of  whom  152  were  in  the  streets  adjoining  the  port.  Most  of  the  men  arrested 
were  foreigners  who  came  directly  from  Copenhagen.  These  improvements  were  all 
assigned  to  prohibition,  which  was  hailed  with  satisfaction  by  the  great  mass  of  the 
workingmen.  On  August  11,  at  Stockholm,  a  meeting  of  20,000  strikers  begged  the 
Government  to  lengthen  the  period  of  prohibition. 

"  By  request  of  Parliament,  the  Government  has  appointed  a  committee  to  investigate 
and  make  clear  how  the  provincial  boards  and  assemblies  (county  councils),  the  com- 
munities, and  the  State  may  be  released  from  economical  dependence  upon  the  drink 
traffic."  3 

1  "Seeing  the  World,"  by  Prohibition  Biplane,  the  American  Prohibition  Yearbook  for  1911.  Chicago 
(National  Prohibition  Press). 

2  Statistisk  Tidskrift,  1912,  p.  123. 

'  Kev.  Clarence  True  Wilson,  D.  D.,  loc.  cit. 


16 


SALE   OF   INTOXICATING   LIQUORS. 


In  Germany  the  temperance  movement  is  making  remarkable  headway  considering 
the  fact  that  for  renturies  beer  drinking  ha?  been  almost  universal.  The  reform  ia 
being  led  by  the  Kaiser,  and  the  history  of  all  reforms  shows  that  they  progress  more 
rapidly  when  led  by  the  "top"  of  society  rather  than  from  the  "bottom."  It  was 
especially  noteworthy  that  at  the  great  International  Hygiene  Exhibition  at  Dresden 
in  1911,  organized  by  German  genius,  a  "demonstration"  of  the  alcohol  exhibit  was 
made  twice  a  day.  In  a  spirit  of  liberality,  brewers  were  allowed  to  make  a  special 
exhibit,  but  the  management  of  the  exhibit,  in  theii"  official  daily  "demonstrations," 
set  forth  the  most  recent  scientific  conclusions,  which  are,  as  has  been  shown  above, 
against  the  use  of  alcohol  as  a  beverage. 

The  decline  in  the  consumption  of  beer  in  Germany  since  l^ftd'is  shown  by  the 


following  diagram: 


120 


I  10 


100 


)^0D 


90 


80 


70 


60 


50 


AO 


30 


20 


10 


1685              1630                 1895                   1900                  1905                   /9I0 

(915 

• 

• 
• 

1 

* 
• 

• 

..>"* 

3eer 

• 
• 
• 

• 

• 

..v-*v 

') 

y*^' 

S/o/r/fs 

.      ^       .  ^« 

V,-'^-''" 

v^'^-^ 

'''■~C- 

*—• — •--• 

Fig.  2. — The  use  of  alcoholic  beverages  in  Germany  in  liters  per  capita.' 

The  Kaiser  is  reported  as  having  said:  "The  nation  which  takes  the  smallest  quan- 
tity of  alcohol  will  win  the  battles  of  the  future." 


'From  the  "Reichsarbeitsblatt,"  March,  1910,  reproduced  from  the  catalogue  of  the  exhibition  on 
alcoholism,  at  the  International  Hygiene  Exhibition,  Dresden,  1911.    Berlin  (Massigkeits-Verlag),  1911. 


SALE   OF  INTOXICATING   LIQUORS.  17 

"Moltke,  himself  an  abstainer,  said:  'Beer  is  a  far  more  dangerous  enemy  to  Ger- 
many than  all  the  armies  of  France.'  "  ' 

Germany,  like  Sweden,  shows  a  very  rapid  decline  in  the  death  rate. 

In  the  United  States  the  per  capita  consumption  of  spirits,  wines,  and  beer  has  as 
yet  shown  little  sign  of  decreasing.  That  of  spirits  is  less  than  it  was  in  1840  to  1870, 
but  is  about  the  same  as  in  1870.  The  consumption  of  wines  has  increased,  with  some 
fluctuations,  from  1S40  to  the  present  time,  while  the  consumption  of  beer  increased 
rapidly  from  1840  to  1890,  since  which  time  it  has  increased  less  rapidly.  During 
the  last  five  years  the  consumption  of  all  three  has  remained  substantially  constant.^ 
It  is  not  unlikely,  therefore,  that  we  are  passing  over  the  crest  of  a  wave,  and  shall 
in  the  next  decade  see  a  substantial  decline  such  as  has  taken  place  in  several  of 
the  countries  of  Europe.  We  are  a  backward  country,  and  far  behind  Sweden,  Ger- 
many, and  England  in  the  appreciation  of  hygiene  in  all  its  branches.  Neverthe- 
less, we  are  beginning  to  be  aroused  to  the  situation,  and  the  death  rate  in  the  United 
States  (registration  area)  has  declined  slightly  during  the  last  decade. 

LONGEVnT. 

To  lower  the  death  rate  means  to  increase  the  length  of  human  life.  Two  genera- 
tions ago  it  was  supposed  that  alcohol  was  conducive  to  longevity.  About  that  time 
an  English  Quaker,  applying  for  life  insurance,  was  charged  a  higher  premium  be- 
cause he  was  a  total  abstainer.  The  basis  for  this  opinion  seems  to  have  been  that 
the  first  societies  of  total  abstainers  showed  a  higher  mortality.  But  this  was  because 
they  consisted  of  reformed  drunkards;  their  death  rate  was  high — -not  because  they 
were  abstainers,  but  because  they  had  previously  been  drunkards.  The  discussion 
to  which  the  rejection  of  the  total  abstainer  gave  rise  led  to  the  formation  of  the 
United  Kingdom  Temperance  and  General  Provident  Institution,  of  London,  whose 
investigations  later  proved  that  abstainers  were  longer  lived  than  nonabstainers. 

An  investigation  of  all  the  deaths  of  men  over  60  years  of  age  in  the  city  of  Chicago 
for  the  month  of  April,  1909,  showed  that  those  who  had  been  drinkers  reached  an 
average  age  of  68  years,  but  those  who  had  not  been  drinkers  reached  an  average  of 
over  72  years.     Nineteen  who  had  not  been  drinkers  passed  the  age  of  80. 

Congressman  Hobson  states:^ 

'  'The  figures  of  the  British  Government  and  English  life  insurance  companies  as  to 
the  effect  of  drinking  on  longevity  are  stated  as- follows: 

"If  a  man  at  the  age  of  20  is  a  total  abstainer  and  remains  a  total  abstainer,  his 
prospect  of  life  is  44  years,  and  he  will  live  to  the  average  age  of  64;  but  if  he  is  a 
temperate  regular  drinker  his  prospect  of  life  will  be  31  years,  and  he  will  live  to  the 
average  age  of  51,  after  losing  13  years  out  of  his  life.  If  he  is  a  heavy  drinker,  his 
prospect  of  life  is  15  years,  and  he  will  die  at  the  average  age  of  35,  after  losing  29 
years  out  of  his  life.  Conservative  estimates  place  the  number  of  confirmed  drunk- 
ards in  the  United  States  at  something  over  1,000,000,  of  whom  300,000  die  every 
year;  the  heavy  drinkers  at  over  4,000,000;  and  temperate  regular  drinkers  at  over 
20,000,000.  A  soldier  wounded  in  battle  and  losing  10  years  of  his  life  as  a  conse- 
quence would  be  classed  as  seriously  wounded.  The  confirmed  drunkards  and 
heavy  drinkers  together,  5,000,000  in  number,  must  be  looked  upon  as  mortally 
wounded  and  the  temperate  regular  drinkers  as  seriously  wounded,  making  a  total 
of  over  25,000,000  Americans  wounded  by  alcohol  to-day,  more  than  10  times  as 
many  as  wounded  in  all  the  battles  of  the  world  since  the  dawn  of  history.  The 
estimates  for  the  white  race  make  over  125,000,000  white  men  to-day  wounded  by 
alcohol." 

INSURANCE. 

In  view  of  the  facts  which  show  the  relation  of  mortality  and  longevity  to  the  use 
of  alcohol  it  is  not  surprising  that  the  life-insurance  companies  are  taking  up  in 
earnest  the  enlightenment  of  the  public  on  the  subject.  The  Postal  Life  Insurance 
Co.  issues  a  series  of  bulletins,  of  which  No.  5*  was  entirely  devoted  to  the  subject 
of  alcohol  and  mortality.     I  quote  from  this  bulletin  as  follows: 

"In  1880  the  per  capita  consumption  of  alcoholic  beverages  in  the  United  States 
was  10.08  gallons.  In  1909  it  reached  21.85  gallons,  an  increase  of  117  per  cent. 
Since  1880  the  death  rate  in  the  registration  States  from  degenerative  diseases  in 
which  alcohol  is  conceded  to  be  an  important  causative  factor  has  increased  104 
per  cent." 

1  Samuel  J.  Barrows,  loc.  cit. 

2  See  Statistical  Abstract  of  the  United  States  of  1910,  p.  544. 

3  Hon.  Richmond  P.  Hobson,  "  The  great  destroyer,"  a  speech  delivered  In  the  House  of  Representa* 
tives,  Feb.  2, 1911. 

*  Apr.  1, 1911. 

42108—12 2 


18  SALE   OF   INTOXICATING   LIQUORS. 

Bulletin  No.  6,'  of  the  same  company,  speaks  again  of  the  effects  of  alcohol: 
"Some  of  the  world's  leading  scientists — Aschaffenburg,  Hodge,  Laitenen,  Krae- 
pelin,  and  others — have  shown  the  destructive  effect  of  alcohol  on  the  nervous 
system  and  its  action  in  lowering  the  resistence  to  the  bacteria  of  disease." 
"  The  Metropolitan  Life  Insurance  Co.,  as  mentioned  above,  publishes  a  bulletin 
called  The  Metropolitan.  One  entire  issue  of  this  bulletin,  which  is  sent  out  to  all 
the  company's  policy  holders,  was  devoted  to  the  subject  of  the  evils  of  alcohol. 

Many  other  insurance  companies  are  issuing  health  bulletins,  in  which  the  use  of 
alcohol  on  the  part  of  policy  holders  is  discouraged.  I  understand  that  out  of  49 
insurance  companies  which  were  circularized  in  regard  to  this  subject,  39  of  them 
replied  that  they  did  not  consider  even  moderate  drinkers  good  risks. 

BIASED   STATEMENTS. 

1  have  tried  to  quote  from  authorities  who  have  approached  the  alcohol  question 
from  a  scientific  point  of  view.  It  would  be  possible  to  make,  with  a  very  good  show 
of  reason,  much  more  extreme  statements,  but  more  difficult  of  ])roof,  based  upon 
the  evidence  of  those  more  or  less  biased  by  their  enthusiasm. 

The  bias  of  enthusiasm,  however,  is  not  so  liable  to  be  misleading  as  the  bias  of 
commercial  interests.  I  have  seen  much  of  the  literatm-e  issued  by  brewers  and  dis- 
tillers and  have  been  struck  by  their  willful  perversion  of  the  truth  and  the  garbled 
quotations  and  misleading  statements.  For  instance,  at  the  great  international 
hygiene  exhibition  the  brewers  (who  were  allowed  to  set  forth  their  claims  for  beer 
as  a  "hygienic"  beverage)  culled  certain  exceptional  statistics  intended  to  show  that 
brewers  were  unusually  long  lived.  These  statistics  were  repudiated  as  misleading 
by  the  statistical  officer  in  the  city  to  which  they  referred.  When  scientific  men  called 
this  fact  to  the  attention  of  the  authorities  of  the  international  hygiene  exhibition, 
they  requested  the  brewers  to  remove  the  misleading  statistics.  This  they  refused 
to  do  and  maintained  that  they  had  a  legal  right  to  keep  the  statistics  there;  where- 
upon the  authorities  of  the  exhibition  put  opposite  the  statistics  a  statement  to  the 
effect  that  they  disclaimed  any  responsibility  for  the  brewers '  statistics. 

One  of  the  most  interesting  examples  of  the  willful  misrepresentation  of  facts  con- 
cerning alcohol  is  the  case  of  a  celebrated  American  whisky  manufacturer,  who  has 
repeatedly  stated  in  the  newspapers  that  whisky — or  at  any  rate  his  particular  brand 
of  whisky — prolongs  human  life.  It  so  happens  that  I  visited  the  city  where  this 
manufactm-er  lives  and  found  that  both  he  and  his  soti  made  a  point  of  being  total 
abstainers  for  the  sake  of  their  health. 

POVERTY   AND    PROSPERITY. 

Since  the  evidence  shows  that  alcohol  impairs  labor  power,  it  is  not  surprising  to 
find  poverty  coexists  with  the  excessive  use  .of  alcohol  and  that  prosperity  increases 
as  the  use  of  alcohol  is  reduced,  as  it  has  increased  in  Sweden,  Germany,  England,  and 
in  certain  places  in  the  United  States.  It  is  claimed  -  that  strong  drink  costs  England 
$2,000,000,000  annually  and  that  the  total  amount  annually  spent  in  the  United 
States  is  over  $4,000,000,000. 

If  the  conclusions  we  have  reached — that  the  use  of  alcohol  as  a  beverage  is  always 
a  net  injury  and  never  a  net  benefit — these  four  billions  annually  are  worse  than 
wasted,  if  a  direct  tax  of  that  amount  were  laid  on  the  citizens  of  the  United  States 
they  would  rise  in  revolt.  And  yet  such  a  tax  would  not  be  so  heavy  a  burden  as  the 
expenditure  for  alcoholic  beverages.  The  tax  would  presumably  be  returned,  in 
part  at  least,  to  the  public — in  the  form  of  public  schools,  good  roads,  the  administra- 
tion of  justice,  and  of  other  governmental  functions.  But  the  expenditure  for  alcohol 
brings  no  return  to  the  public  and  no  return — except  a  delusive  gratification — to  the 
individual.  On  the  contrary,  it  increases  public  and  private  burdens.  It  increases 
public  burdens  by  necessitating  greater  expenditures  for  jails,  police,  and  courts, 
penitentiaries,  insane  asylums,  hospitals,  and  j)oorhouses;  and  it  increases  private 
burdens  by  impairing  earning  power  and  undermining  moral  character.  The  drinker 
not  only  robs  his  family  of  the  earnings  he  spends  on  alcohol,  but  he  robs  them  of  the 
earnings  he  loses  from  unemployment  due  to  drunkenness,  from  illness,  accident,  and 
other  disabilities  due  to  the  use  of  the  drug  and  from  the  resulting  shortening  of  his 
life;  while,  further,  he  robs  them  of  himself,  his  companionship,  and  personal  care. 
If  all  of  these  disadvantages  could  be  appraised  in  cash  and  added  to  the  billions 
directly  spent  the  total  figure  would  probably  be  manyfold  larger  that  at  first  appears; 
and  the  worst  feature  of  it  is  that  the  greater  part  of  this  crushing  weight  rests  on  the 

'  Hon.  Richmond  P.  Hobson,  "  The  great  destroyer,"  a  speech  delivered  in  the  House  of  Repre- 
sentatives, Sept.  1,  1911. 

2  American  Prohibition  Yearbook,  loc.  cit. 


SALE   OF   INTOXICATING   LIQUOES.  19 

shoulders  least  able  to  bear  it — the  shoulders  of  the  workingman.  The  wealthy  can 
better  bear  loss  of  income  and  efficiency,  but  such  losses  to  the  workman  spell  poverty 
and  misery.  The  committee  of  fifty  found  that  of  the  poverty  which  came  under  the 
notice  of  the  charity  organization  societies  about  25  per  cent  could  be  traced,  directly 
or  indirectly,  to  the  use  of  liquor;  of  the  poverty  found  in  almshouses  about  37  per  cent. 

Carroll  D.  Wright,  formerly  United  States  Commissioner  of  Labor,  stated:  ' 

"I  have  looked  into  a  thousand  homes  of  the  working  people  of  Europe;  I  do  not 
know  how  many  in  this  country.  In  every  case,  so  far  as  my  observation  goes,  drunken- 
ness was  at  the  bottom  of  the  misery  and  not  the  industrial  system  or  the  industrial 
surrounding  of  the  men  and  their  families." 

Whether  or  not  ''Prohibition  Kansas"  can  be  held  responsible  for  all  improvement 
in  that  State,  it  is  certainly  true  that  the  State  has  made  great  strides  since  prohibition 
was  introduced.     The  American  Prohibition  Yearbook  states:^ 

"As  a  consequence  of  having  no  paupers,  the  j^oor  farms  of  more  than  50  counties 
have  been  turned  into  experiment  stations  under  the  control  of  the  State  Agricultural 
College,  and  are  now  called  'Prosi^erity  farms.' 

"In  the  25  cities  of  Kansas  the  percentage  of  home  owners  is  greater  and  the  percent- 
age of  renters  smaller  than  in  the  cities  of  any  other  State  in  the  Union. 

"The  wealth  of  the  State  has  increased  at  the  rate  of  112,000,000  per  year  for  the 
last  decade." 

PUBLIC   OPINION. 

With  so  much  evidence  showing  the  harmfulness  of  alcohol,  why,  then,  is  it  still 
consumed?  The  truth  is,  in  my  opinion,  that  the  consumption  of  alcohol  is  kept  up 
by  tradition,  by  the  assumption  that  so  prevalent  a  practice  must  have  virtues,  by 
the  fear  of  individuals  to  break  away  from  custom,  and  by  the  well  known  difficulty 
of  emancipating  one's  self  from  any  drug  habit.  If  we  look  at  the  alcohol  habit 
squarely  we  see  that  it  is  merely  one  of  the  harmful  drug  habits — like  opium  in  China, 
hasheesh  in  Turkey,  cocaine,  etc.  It  is  a  poison,  and  its  evil  effects  are  so  great  that 
every  courageous  man  should  help  to  eliminate  it.  Had  Lincoln  lived  he  intended, 
after  destroying  slavery,  to  attack  alcohol.  This  I  have  on  the  authority  of  a  living 
witness  and  friend  of  Lincoln.     Lincoln  is  reported  to  have  said :  ^ 

"The  liquor  traffic  is  a  cancer  in  society,  eating  out  the  vitals  and  threatening 
destruction,  and  all  attempts  to  regulate  it  will  not  only  prove  abortive,  but  will 
aggravate  the  evil.  There  must  be  no  more  attempts  to  regulate  the  cancer.  It  must 
be  eradicated,  not  a  root  must  be  left  behind;  for,  until  this  is  done,  all  classes  must 
continue  in  danger  of  becoming  victims  of  strong  drink." 

President  Taft  has  become  a  total  abstainer.  The  Kaiser  of  Germany  and  his  family 
have  also  given  up  the  use  of  intoxicating  liquors.  On  this  subject.  President  Emeritus 
Charles  W.  Eliot,  of  Harvard,  another  recent  recruit  in  the  antialcohol  column,  says:^ 

"Recent  researches  in  physiology  and  medicine  tend  strongly  to  show  that  even 
the  moderate  drinking  of  alcohol  is  inexpedient.  *  *  *  No  longer  are  men  who  are 
to  be  exposed  to  cold,  heat,  fatigue,  or  hardships  of  any  sort,  prepared  or  braced  for 
such  encounters  by  any  form  of  alcohol.  No  captain  of  an  ocean  liner  ever  supports 
himself  now  against  the  fierce  exposures  of  the  bridge  by  means  of  alcohol." 

Dr.  Amos  P".  Wilder,  United  States  consul  general,  Shanghai,  says:* 

"In  my  journalistic  and  consular  career  I  have  seen  so  many  go  down — so  many 
careers  wi-ecked,  and  so  much  wi-etchedness  among  the  innocent  caused  by  the  igno- 
rance of  those  who  begin  the  drink  habit — that  I  must  respond  to  any  opportunity  to 
aid  in  informing  men,  especially  young  men,  what  a  dangerous  thirst  they  are  engen- 
dering. I  am  familiar  with  that  confident  saying  in  the  flush  of  strength,  'I  can  take 
it  or  let  it  alone,'  and  I  know  the  poor  neglected  wretch  who  says  he  wants  a  job,  or  a 
night's  lodging,  or  a  dollar,  and  finally  confesses  that  what  he  wants,  and  must  have,  is 
a  drink.     One  can  stop  and  wont:  the  other  would  stop,  but  can't." 

Physicians  are  beginning  to  give  up  alcohol  in  their  practice.  The  marked  decline 
in  the  use  of  alcohol  as  a  medicine  is  significant  of  the  trend  of  the  times.     It  will 

{)robal)ly  soon  come  aliout  that  almost  the  only  alcoholic  medicines  will  be  the  out- 
awed  "patent"  or  proprietary  medicines  containing  alcohol.  Dr.  Mary  Sturge  * 
writes  that  an  example  of  the  decrease  in  the  use  of  alcohol  for  medicinal  purposes  is 
shown  in  the  treatment  of  fever  in  the  British  Metropolitan  Asylums  Board.     WTiile 

1  What  People  Have  Said  About  Whisky,  by  H.  Parker  Willis. 

2  Loc.  cit. 

3  In  an  address  to  the  Massachusetts  No-I.icense  League,  in  Boston,  29th  of  October,  1908. 
<  In  an  address  before  the  Loyal  Temperance  Legion,  in  Shanghai,  Oct.  10, 1911. 

6  Quoted  by  George  B.  Wilson,  loc.  cit. 


20  SALE    OF   INTOXICATING   LIQUORS. 

the  niimher  of  patients  has  increased  from  19,937  in  1894  to  27,570  in  1909,  the  cost  of 
stimulants  for  treatment  has  decreased  from  £1,388  in  1894  to  £251  in  1909.  Dr. 
Stiirge  says:  * 

"The  immediate  deduction  from  these  figures  is  that  whereas  up  to  10  years  ago 
alcohol  was  extensively  used  in  the  treatment  of  fevers,  it  is  now  recognized  that  the 
disadvantages  attendant  on  its  employment  often  outweigh  any  prospective  advan- 
tages to  1)0  obtained  from  its  routine  application." 

"Alcohol  is  almost  entirely  banished  from  the  hospital,"  says  George  B.  Wilson,* 
who  further  states: ' 

"In  July,  1904,  no  fewer  than  14,718  members  of  the  medical  profession  petitioned 
the  [British]  Board  of  li^ducation  in  favor  of  the  compulsory  teaching  of  hygiene  and 
the  nature  and  effects  of  alcohol  in  all  pul)lic  elementary  schools.  The  promoters  of 
this  movement  were  the  most  eminent  leaders  of  the  profession,  such  as  Sir  ^^'illiam 
Broadbent,  Sir  Thonias  Barlow,  Sir  Lauder  Brunton,  Sir  Victor  Horsley,  and  others." 

The  fight  against  alcohol  is  only  one  phase  of  the  general  tight  for  health  and  effi- 
ciency. Experience  has  shown  that  the  best  way  to  get  rid  of  alcohol  is  to  restore 
the  conditions  for  a  healthy  life.  The  introduction  of  healthful  outdoor  sports  reduces 
the  consumption  of  alcohol.  The  evidence  presented  1  ly  Mr.  Wilson '  indicates  that  one 
of  the  most  potent  factors  in  reducing  the  use  of  alcohol  has  been  the  increased  inter- 
est in  athletics  and  out-of-door  life  in  England.  Alcohol  is  an  al)normal  craving  and 
apparently  comes  from  an  almormal  method  of  living,  so  that  the  craving  is  diminished 
in  proportion  as  normal  conditions  are  restored.  It  is  probable  that  the  use  of  the 
bicycle  has  had  some  effect  on  the  decline  in  the  consumption  of  intoxicating  drinks 
in  the  United  Kingdom.  At  any  rate  cycling  has  increased  at  the  same  time  that 
drinking  has  decreased. 

The  saloon  has  always  been  a  sort  of  workingman's  club,  and  has  furnished  amuse- 
ment when  few  amusements  wliich  were  normal  and  natural  were  available.  The 
chief  constables  of  York,  Swansea,  Gateshead,  Coventry,  and  Airdrie,  are  c^uoted  by 
Mr.  Wilson  '  as  sul)stantiating  his  opinion  that  the  growth  of  simple,  innocent,  and 
healthful  amusements  are  counter  attractions  to  the  saloon  and  to  the  use  of  alcoliol. 
It  is  his  belief  that  the  temperance  reform  is  a  permanent  change  in  the  habits  of  the 
people,  due  to  the  gradual  understanding,  through  educational  means  and  otherwise, 
of  the  physiological  evils  of  alcoiiol  and  the  benefits  to  be  derived  from  healthier  modes 
of  recreation.     Mr.  Wilson  says:  • 

"On  April  10,  1905,  the  Right  Hon.  Austen  Chamberlain,  M.  P.,  in  his  speech  when 
introducing  the  budget,  sa'id  that  he  thought  that  the  decline  in  the  consumption  of 
intoxicants  in  the  United  Kingdom  was  due,  in  a  large  measure,  to  the  growth  of 
amusements,  such  as  outdoor  games,  theaters,  music  halls,  cheap  railway  excursions, 
etc.,  which  were  increasingly  absorbing  the  time  and  the  money  of  the  people." 

"Above  all,"  says  the  Right  Hon.  John  Burns,  M.  P.,^  "give  the  people  homes 
more  homes,  larger  homes,  cleaner  homes,  and  sweeter  homes.     Abolish  the  slum. 
Raise  wages.     Improve  the  sanitation,  appearance,  and  environment  of  the  factories! 
and  workshops.     Humanize  industry — then  labor  will  not  seek  degradation  in  drink' 
or  low  company  in  public  houses.     Convert  the  schools  into  club  rooms,  where  friendly 
societies  and  trade  unions  and  thrift  and  other  organizations  can  meet  and  do  theirJ 
business.     Disestalilish  the  puljlic  house  as  a  house  of  call,  divest  it  of  all  the  functions,! 
traditions,  and  accessories  that  through  the  ages  it  has  taken  to  itself  in  matters  of 
local  life,  civic  interest,  social  attractiveness.     Divert  to  the  city  hall,  the  local  library, 
the  municipal  concert  hall,  the  park,  the  gymnasium,  and  the  municipal  parlor,  those 
good  things  which  drink  has  craftily  yoked  to  its  chariot,  then  the  beginning  of  the 
end  of  the  reign  of  King  Bung  will  have  commenced." 

1  Quoted  by  George  B.  Wilson,  loc.  cit. 

"  A  speech  in  Free  Trade  Hall,  Oct.  31, 1904. 


o 


THIS  BOOK  IS  DUE  ON  THE  LAST  DATE 
STAMPED  BELOW 

AN  INITIAL  FINE  OF  25  CENTS 

WILL   BE   ASSESSED    FOR    FAILURE  TO    RETURN 
THIS    BOOK    ON    THE    DATE    DUE.    THE    PENALTY 
WILL  INCREASE  TO   SO  CENTS  ON  THE  FOURTH 
DAY    AND    TO     $1.00    ON    THE    SEVENTH     DAY 
OVERDUE. 

mm 

m\ 

LW  mmm 

LD  21-100ot-12,'43  (8796s) 

m 


U-C.  BERKELEY  LIBRARIES 


CD5T3T3M2E 


MJ203507 


UBRA 


PUBUC 
HEALTH 

UBRARY  ' 

THE  UNIVERSITY  OF  CAUFORNIA  UBRARY 


"X 


& 


I 


